Appropriate Follow-Up Strategies for Gastrointestinal Stromal Tumor Patients Based on the Analysis of Recurrent Interval and Patterns

Abstract

Background/Aims: Previous studies have proposed risk classifications for patients with gastrointestinal stromal tumor (GIST) after resection and have contributed to the prediction of its prognosis. However, optimal postoperative surveillance has not yet been established. Methods: We retrospectively analyzed data from 115 GIST patients who experienced recurrence after complete resection. The relationships between clinicopathological characteristics and the first recurrence sites, or time to recurrence (TTR), were investigated. We also compared the characteristics between 2 subgroups based on a TTR of ≤5 or >5 years. Results: The first recurrence occurred in the abdomen in 114 of 115 patients (99.1%); one case of esophageal GIST recurred in the lung. Gastric and small intestinal GISTs recurred most frequently in the liver or peritoneum, while the most common recurrences of colorectal GISTs were found to be local. Fourteen patients (12.2%) experienced recurrence after >5 years. Smaller tumors and those categorized as lower risk were significantly more frequent in the TTR >5 years group than in the TTR ≤5 years group. In the TTR >5 years group, local recurrence was the most frequent type of recurrence (42.9%). Conclusion: Based on abdominal examination, postoperative surveillance after complete resection for primary GISTs may be recommended for >5 years.

Late recurrence of low‑risk gastrointestinal stromal tumor of jejunum diagnosed 30 years after tumor resection: A case report and literature review

“…In one study conducted by Italian researchers ( 6 ), reviews of 42 patients who underwent treatment for GIST recurrence in their institution indicated that the incidence of patients with late recurrence of five years or later was 14%. One Japanese study of 115 patients who developed recurrence after surgery ( 22 ) revealed that the incidence of late recurrence was 12.2%. These findings suggest that five-year follow-up is insufficient to determine the oncological outcomes of GIST patients, and longer follow-up is required.…”

“…However, there is no known clinicopathological feature that can enable the effective selection of patients requiring long follow-up of more than five years. Although the above-mentioned Japanese study ( 22 ) revealed that small and low-risk GISTs were frequently found in cases of late GIST recurrence, those features are substantially useless for patient selection.…”

Utility of noncontrast MRI in the detection and risk grading of gastrointestinal stromal tumor: a comparison with contrast-enhanced CT

“…Risk stratification of each primary GIST was defined on the basis of histopathological reports which were graded using the modified National Institutes of Health criteria, including factors such as tumor diameter, site, mitotic index, and presence of rupture at surgery (21). Patients with moderate-to-high risk GISTs were categorized into the high-risk recurrence group (H-group, higher recurrence rate within 5 years) and patients with very-low-and-low risk GISTs were assigned to a low-risk recurrence group (L-group, lower recurrence rate within 5 years) (22,23).…”