Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients

Abstract

BackgroundGastrointestinal stromal tumors (GIST) are mesenchymal tumors of the gastrointestinal tract, usually kit-positive, that are believed to originate from interstitial cell of Cajal, or their related stem cells. The most common clinical presentation of these tumors is gastrointestinal bleeding, otherwise they may cause intestinal obstruction, abdominal pain, a palpable mass, or can be incidentally detected during surgery or endoscopic/radiological procedures. Prognosis is related to the size of the tumor and to the mitotic rate; other prognostic factors are tumor location, tumor resection margins, tumor rupture, and c-kit mutation that may interfere with molecular target therapy efficacy.AimPrimary aim of this study was to report our experience regarding GIST patients, correlating symptoms at presentation with tumor localization and risk factors.Patients and methods47 consecutive patients undergone to surgical resection for GISTs were enrolled in a prospective study from December 1999 to March 2009. Patient's clinical and pathological features were collected and analysed.ResultsThe most common symptom was abdominal pain. Bleeding in the digestive tract and abdominal pain were more frequent in gastric GISTs (58% and 61%); acute abdominal symptoms were more frequent in jejunal and ileal GISTs (40% and 60%), p < 0.05. We reported a mild correlation between the mitotic rate index and symptoms at presentation (p 0.074): this correlation was stronger if GISTs causing "acute abdominal symptoms" were compared with GISTs causing "abdominal pain" as main symptom (p 0.039) and with "incidental" GISTs (p 0.022).We observed an higher prevalence of symptomatic patients in the "high risk/malignant group" of both the Fletcher's and Miettines's classification (p < 0.05).ConclusionAccording with our findings symptoms correlate to tumor location, to class risk criteria as mitotic index and risk classifications, however we cannot conclude that symptoms are per se predictive of survival or patient's outcome.

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

“…Stomach is the most common site with 60%, while small bowel constitutes 20-30% in western countries (20,21). Studies from Japan also supports stomach as the most common site (up to 70%) (22).…”

Neurofibromatosis type 1 associated with pheochromocytoma and gastrointestinal stromal tumors: A case report and literature review

“…Although 60% of GISTs occur in the stomach whilst only 20-30% occur in the small intestine (28), NF1-related GISTs (NF1-GIST) tend to be located in the small intestine (28). The pathogenesis of NF1-GIST is different to that of sporadic GIST.…”

Outcome of surgical resection for localized gastrointestinal stromal tumors

“…In contrast to Caterino and his co-workers who demonstrated an association between diminished survival and emergency presentation of GISTs, both patients who received emergency resection survived during entire follow up period. 15 An analysis of data from ten population-based studies revealed that the 5-year recurrence-free survival rates for GISTs treated with surgery alone was approximately 70%. 15 The median postoperative follow up period was 21 (range: 8-48) months.…”

“…15 An analysis of data from ten population-based studies revealed that the 5-year recurrence-free survival rates for GISTs treated with surgery alone was approximately 70%. 15 The median postoperative follow up period was 21 (range: 8-48) months. Overall, 13 patients (87%) among the study cohort while 10 patients (67%) had recurrence-free survival.…”