Gastrointestinal Stromal Tumors (GIST): A Prospective Evaluation of Risk Factors and Prognostic Scores

Sánchez-Hidalgo, Juan Manuel; Peña, Sebastián Rufían; Bru, Rubén Ciria; Torres, A. Naranjo; Casares, Cristobal Muñoz; Rabelo, J. Ruiz; Delgado, Javier Briceño

doi:10.1007/s12029-009-9102-y

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…It supports the fact that other factors are to be considered to predict patterns of recurrence. Tumour mitotic rate, size and location of the tumour, c-kit codons 557 to 559 exon 11 deletion, exon 13 and 17 mutations, and intraoperative tumour capsule rupture have all recently been proven to be independent predictors of recurrence [48–51]. Future adjuvant and neoadjuvant trials should take these factors into consideration.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial

Doyon

Sidéris

Leblanc

et al. 2012

International Journal of Surgical Oncology

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Purpose. Proven efficacy of imatinib mesylate in gastrointestinal stromal tumour (GIST) has led to its use in advanced disease and, more recently, in adjuvant and neoadjuvant settings. The purpose of this study was to evaluate the optimal neoadjuvant imatinib duration to reduce the morbidity of surgery and increase the possibility of resection completeness in advanced tumours. Patients and Method. Patients with advanced GIST were enrolled into a registered open-label multicenter trial and received imatinib daily for a maximum of 12 months, followed by en bloc resection. Data were prospectively collected regarding tumour assessment, response rate, surgical characteristics, recurrence, and survival. Results. Fourteen patients with advanced GIST were enrolled. According to RECIST criteria, 6 patients had partial response and 8 had stable disease. The overall tumour size reduction was 25% (0–62.5%), and there was no tumour progression. Eleven patients underwent tumour resection, and all had R0 resection. After a median followup of 48 months, 4-year OS and DFS were 100% and 64%, respectively. Conclusion. This prospective trial showed that one year of neoadjuvant imatinib in advanced GIST is safe and associated with high rate of complete microscopic resection. It is not associated with increased resistance, progression, or complication rates.

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Section: Discussionmentioning

confidence: 99%

Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial

Doyon

Sidéris

Leblanc

et al. 2012

International Journal of Surgical Oncology

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“…Several risk stratification models have been proposed to estimate the risk of recurrence and identify high risk GISTs after resection, so the indication of adjuvant Imatinib can be individualized. In multiples models, the main predictors of recurrence established were tumor mitotic rate, size, and location[ 47 , 101 ]. Increased tumor size, high mitotic activity, or extragastric location such as small bowel, colon, rectum, or mesentery is associated with an increased risk of poor outcomes.…”

Section: Adjuvant Therapymentioning

confidence: 99%

Gastrointestinal stromal tumors: A multidisciplinary challenge

Sánchez-Hidalgo¹,

Durán²,

Molero-Payan³

et al. 2018

WJG

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

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Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

Liu

Jiang

et al. 2012

Front. Med.

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In order to find out the potential indicators predicting prognosis of malignant gastrointestinal stromal tumors (GISTs) after surgical resection, we collected clinical records of 80 patients with malignant GISTs. Tumor location, size, mitotic index, necrosis were compared with the prognosis of malignant GISTs by Kaplan-Meier method and log-rank test. After a median follow-up of 844 days (52-2 145), we found that as National Institutes of Health suggested, tumors with intermediate risk had more favorable prognosis than that with high risk. Their 3-year survival rate were 65.3% and 41.3%, respectively (P < 0.001). Moreover, tumor size and mitotic index were associated with free survival. The 3-year survival rate for patients with tumor size ≤ 10 cm and > 10 cm were 62.3% and 41.8%, respectively (P = 0.002), Tumors with mitotic index ≤ 5/50 HPF had a higher 3-year survival rate than tumors with mitotic index > 5/50 HPF (67.1% versus 40.7%, P = 0.005). The presence of necrosis was directly related to the malignant behavior. The 3-year survival rate for presence and absence necrosis were 50.8% and 64.8% (P = 0.008). From the present study, we can conclude that besides tumors size and mitotic index, tumor location and necrosis also influence on the long-term survival of patient with malignant GISTs after surgical resection.

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Gastrointestinal Stromal Tumors (GIST): A Prospective Evaluation of Risk Factors and Prognostic Scores

Cited by 5 publications

References 21 publications

Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial

Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial

Gastrointestinal stromal tumors: A multidisciplinary challenge

Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

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