Gastrointestinal stromal tumors of the colon and rectum

Roşulescu, Alexandra; Pechianu, Nicolae; Hortopan, M.; Mihai, Mihaela; Dima, Simona; Stroescu, Cezar; Zamfir, Radu; Brasoveanu, Vladislav; Diller, Leonard; Vasilescu, C; Popescu, Irinel; Herlea, Vlad

doi:10.5114/pjp.2020.99786

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…With larger tumors, preoperative treatment should first be considered, and the rate of pancreaticoduodenectomy should be minimized. The degree of malignancy of colorectal stromal tumors is higher than that of small intestine and gastric stromal tumors[ 24 ], and the risk of recurrence is the highest. GISTs generally occur most frequently in middle-aged and elderly people, and the most common onset is between 50 and 70 years old[ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Development of an innovative nomogram of risk factors to predict postoperative recurrence of gastrointestinal stromal tumors

Guan¹,

Wang²,

Ma³

et al. 2022

World J Gastrointest Surg

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BACKGROUND There are many staging systems for gastrointestinal stromal tumors (GISTs), and the risk indicators selected are also different; thus, it is not possible to quantify the risk of recurrence among individual patients. AIM To develop and internally validate a model to identify the risk factors for GIST recurrence after surgery. METHODS The least absolute shrinkage and selection operator (LASSO) regression model was performed to identify the optimum clinical features for the GIST recurrence risk model. Multivariable logistic regression analysis was used to develop a prediction model that incorporated the possible factors selected by the LASSO regression model. The index of concordance (C-index), calibration curve, receiver operating characteristic curve (ROC), and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the predictive model. Internal validation of the clinical predictive capability was also evaluated by bootstrapping validation. RESULTS The nomogram included tumor site, lesion size, mitotic rate/50 high power fields, Ki-67 index, intracranial necrosis, and age as predictors. The model presented perfect discrimination with a reliable C-index of 0.836 (95%CI: 0.712-0.960), and a high C-index value of 0.714 was also confirmed by interval validation. The area under the curve value of this prediction nomogram was 0.704, and the ROC result indicated good predictive value. Decision curve analysis showed that the predicting recurrence nomogram was clinically feasible when the recurrence rate exceeded 5% after surgery. CONCLUSION This recurrence nomogram combines tumor site, lesion size, mitotic rate, Ki-67 index, intracranial necrosis, and age and can easily predict patient prognosis.

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Section: Discussionmentioning

confidence: 99%

Development of an innovative nomogram of risk factors to predict postoperative recurrence of gastrointestinal stromal tumors

Guan¹,

Wang²,

Ma³

et al. 2022

World J Gastrointest Surg

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“…Meanwhile, colorectal GISTs remain a predicament for clinicians and scientists to predict clinical behavior. Previous studies have reported the prognostic factors affecting prognosis in the patients with colorectal GISTs, but the majority of the published literature concerning the characteristics, incidence, survival, and treatment strategies of colorectal GISTs has been case reports or small case series (7,(36)(37)(38). Although these findings advanced our understanding of colorectal GISTs, they may be particularly susceptible to patient selection bias and institutional bias, and there is still a voracious need for more information on this uncommon malignant tumor.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prognostic model to predict the prognosis of patients with colorectal gastrointestinal stromal tumor: A large international population-based cohort study

Zhang²,

Fu³

et al. 2022

Front. Oncol.

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BackgroundColorectal gastrointestinal stromal tumors (GISTs), mesenchymal malignancy, only accounts for about 6% of GISTs, but prognosis is generally poor. Given the rarity of colorectal GISTs, the prognostic values of clinicopathological features in the patients remain unclear. Nomograms can provide a visual interface to help calculate the predicted probability of a patient meeting a specific clinical endpoint and communicate it to the patient.MethodsWe included a total of 448 patients with colorectal GISTs diagnosed between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. For nomogram construction and validation, patients in the SEER database were divided randomly into the training cohort and internal validation cohort at a ratio of 7:3, while 44 patients with colorectal GISTs from our hospital patient data set between 2010 to 2016 served as the external validation cohort. The OS curves were drawn using the Kaplan–Meier method and assessed using the log-rank test. And, Fine and Gray’s competing-risks regression models were conducted to assess CSS. We performed univariate and multivariate analyses to select prognostic factors for survival time and constructed a predictive nomogram based on the results of the multivariate analysis.ResultsThrough univariate and multivariate analyses, it is found that age, primary site, SEER stage, surgery, and tumor size constitute significant risk factors for OS, and age, primary site, histological grade, SEER stage, American Joint Committee for Cancer (AJCC) stage, surgery, and tumor size constitute risk factors for CSS. We found that the nomogram provided a good assessment of OS and CSS at 1-, 3- and 5- year in patients with colorectal GISTs. The calibration plots for the training, internal validation and external validation cohorts at 1-, 3- and 5- year OS and CSS indicated that the predicted survival rates closely correspond to the actual survival rates.ConclusionWe constructed and validated an unprecedented nomogram to predict OS and CSS in patients with colorectal GISTs. The nomogram had the potential as a clinically predictive tool for colorectal GISTs prognosis, and can be used as a potential, objective and additional tool for clinicians in predicting the prognosis of colorectal GISTs patients worldwide. Clinicians could wield the nomogram to accurately evaluate patients’ OS and CSS, identify high-risk patients, and provide a baseline to optimize treatment plans.

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“…Consistent with their incidence in the esophagus and the duodenum, GISTs situated in the colorectum are similarly rare. Compared with the left colon, GISTs tend to occur in the right side ( 85 ). All colon GISTs are recommended to be surgically resected regardless of tumor size and malignancy degree ( 86 ).…”

Section: Surgical Management In Gastrointestinal Stromal Tumorsmentioning

confidence: 99%

Advances of endoscopic and surgical management in gastrointestinal stromal tumors

2023

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As one of the most common mesenchymal malignancies in the digestive system, gastrointestinal stromal tumors (GISTs) occur throughout the alimentary tract with diversified oncological characteristics. With the advent of the tyrosine kinase inhibitor era, the treatment regimens of patients with GISTs have been revolutionized and GISTs have become the paradigm of multidisciplinary therapy. However, surgery resection remains recognized as the potentially curative management for the radical resection and provided with favorable oncological outcomes. The existing available surgery algorithms in clinical practice primarily incorporate open procedure, and endoscopic and laparoscopic surgery together with combined operation techniques. The performance of various surgery methods often refers to the consideration of risk evaluation of recurrence and metastases; the degree of disease progression; size, location, and growth pattern of tumor; general conditions of selected patients; and indications and safety profile of various techniques. In the present review, we summarize the fundamental principle of surgery of GISTs based on risk assessment as well as tumor size, location, and degree of progress with an emphasis on the indications, strengths, and limitations of current surgery techniques.

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Gastrointestinal stromal tumors of the colon and rectum

Cited by 4 publications

References 31 publications

Development of an innovative nomogram of risk factors to predict postoperative recurrence of gastrointestinal stromal tumors

Development of an innovative nomogram of risk factors to predict postoperative recurrence of gastrointestinal stromal tumors

Development and validation of a prognostic model to predict the prognosis of patients with colorectal gastrointestinal stromal tumor: A large international population-based cohort study

Advances of endoscopic and surgical management in gastrointestinal stromal tumors

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