Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts

Joensuu, Heikki; Vehtari, Aki; Riihimäki, Jaakko; Nishida, Toshirou; Steigen, Sonja Eriksson; Brabec, Peter; Plank, L; Nilsson, Bengt; Crimi, Claudia; Braconi, Chiara; Bordoni, Andrea; Magnússon, Magnús K.; Linke, Zdeněk; Šufliarský, Jozef; Federico, Massimo; Jonasson, Jón G.; Tos, Angelo Paolo Dei; Rutkowski, Piotr

doi:10.1016/s1470-2045(11)70299-6

Cited by 816 publications

(807 citation statements)

References 24 publications

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“…Regardless, there is no doubt that a risk categorization of continuous biological variables such as size and mitotic rate is problematic. In this regard, prognostic contour maps as described by Joensuu et al [15] are helpful in assessing the risk of recurrence in GIST patients. The main advantage of these contour maps is that minor changes in size and mitotic rate do not result in major changes in the individual patient's risk estimation.…”

Section: Discussionmentioning

confidence: 99%

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

et al. 2015

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Background The objective of the present analysis was to assess whether small bowel gastrointestinal stromal tumor (GIST) is associated with worse cancer-specific survival (CSS) and overall survival (OS) compared with gastric GIST on a population-based level. Patients and methods Data on patients aged 18 years or older with histologically proven GIST was extracted from the SEER database from 1998 to 2011. OS and CSS for small bowel GIST were compared with OS and CSS for gastric GIST by application of adjusted and unadjusted Cox regression analyses and propensity score analyses. Results GIST were located in the stomach (n = 3011, 59 %), duodenum (n = 313, 6 %), jejunum/ileum (n = 1288, 25 %), colon (n = 139, 3 %), rectum (n = 172, 3 %), and extraviscerally (n = 173, 3 %). OS and CSS of patients with GIST in the duodenum [OS, HR 0.95, 95 % confidence interval (CI) 0.76-1.19; CSS, HR 0.99, 95 % CI 0.76-1.29] and in the jejunum/ileum (OS, HR 0.97, 95 % CI 0.85-1.10; CSS, HR = 0.95, 95 % CI 0.81-1.10) were similar to those of patients with gastric GIST in multivariate analyses. Conversely, OS and CSS of patients with GIST in the colon (OS, HR 1.40; 95 % CI 1.07-1.83; CSS, HR 1.89, 95 % CI 1.41-2.54) and in an extravisceral location (OS, HR 1.42, 95 % CI 1.14-1.77; CSS, HR = 1.43, 95 % CI 1.11-1.84) were significantly worse than those of patients with gastric GIST. Conclusions Contrary to common belief, OS and CSS of patients with small bowel GIST are not statistically different from those of patients with gastric GIST when adjustment is made for confounding variables on a population-based level. The prognosis of patients with nongastric GIST is worse because of a colonic and extravisceral GIST location. These findings have implications regarding adjuvant treatment of GIST patients. Hence, the dogma that small bowel GIST patients have worse prognosis than gastric GIST patients and therefore should receive adjuvant treatment to a greater extent must be revisited.

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Section: Discussionmentioning

confidence: 99%

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

et al. 2015

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“…Whether to redefine the risk stratification standard to address different tumor origin is pending further discussion. The Armed Forces Institute of Pathology classification of GISTs, which classifies GIST according to different tumor sites, has the potential to replace or supplement the NIH classification for use in patients from China (Joensuu et al 2012). Hou et al (2010) pointed out that a standard established based merely on two indicators, including tumor size and mitotic counts, is not capable of differentiating malignant from nonmalignant GIST.…”

Section: Discussionmentioning

confidence: 99%

Tumor Sites and Microscopic Indicators Are Independent Prognosis Predictors of Gastrointestinal Stromal Tumors

Zhao

Wang

et al. 2014

Tohoku J. Exp. Med.

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Gastrointestinal stromal tumors (GISTs) are the most common among gastrointestinal mesenchymal tumors, but its prognosis has not been accurately predicted by the current risk stratification guidelines, National Institutes of Health classification. In this study, we evaluated the predictive factors for GIST prognosis in a retrospective analysis of 332 patients. The data collected included tumor sites, including the esophagus, stomach, duodenum, small intestine, and extragastrointestinal sites; tumor size; microscopic indicators for malignant tumor behavior, such as the number of dividing cells, cell necrosis, atypical morphology, and invasion into the muscular or mucous layer; and previously established immunohistochemical indicators, CD117, CD34, and discovered on GIST-1 (DOG-1). No single occurrence of any microscopic indicators correlated with the prognosis of GIST; however, the total number of microscopic indicators was a significant prognostic factor of GIST (P < 0.001). Regarding the tumor sites, the order of prognostic risk (from the lowest to the highest) was as follows: the esophagus, stomach, duodenum, small intestine, extragastrointestinal sites, and colorectum. The association between tumor sites and prognosis was significant (P < 0.001). On the other hand, the expression of CD117 or CD34 was not associated with the risk of GIST. Importantly, 91% of the patients (302/332) showed the expression of DOG-1, and the lack of DOG-1 expression was associated with poor prognosis (P < 0.05). In conclusion, both tumor sites and total number of microscopic indicators are independent risk factors associated with the prognosis of GIST. The lack of DOG-1 expression may be predictive of malignant outcome.

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“…The current risk stratification systems are based on tumor size, mitotic activity, tumor rupture, and tumor location (34)(35)(36)(37). However, when these systems were established, only a few esophageal GISTs were included in risk assessment, and the accuracy of these systems for determining the prognosis of patients with esophageal GISTs is unknown (13).…”

Section: Pathological Diagnosis and Gene Expression Profilingmentioning

confidence: 99%

Gastrointestinal stromal tumor of the esophagus: current issues of diagnosis, surgery and drug therapy

Hihara

Mukaida

Hirabayashi

2018

Transl. Gastroenterol. Hepatol.

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Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts

Cited by 816 publications

References 24 publications

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

Tumor Sites and Microscopic Indicators Are Independent Prognosis Predictors of Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumor of the esophagus: current issues of diagnosis, surgery and drug therapy

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