Tumor necrosis is significantly associated with reduced recurrence‐free survival after curative resection of gastrointestinal stromal tumors

Tyler, Robert; Davies, Emma; Tan, Dominic Ti Ming; Hodson, James; Taniere, Philippe; Thway, Khin; Jafri, Mariam; Almond, Max; Ford, Samuel J.; Strauß, D.; Hayes, Andrew; Smith, Myles; Desai, Anant

doi:10.1002/jso.26294

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…Surprisingly, tumor size was not related to DFS in the univariate or multivariate Cox regression models after PSM ( Table 3 ). Tumor necrosis was a key risk factor for not including EGIST data in previous studies [ 21 ], which was inconsistent with the current finding that tumor necrosis was not an independent risk factor in the multivariate Cox regression model (Tables 2 and 3 ). In any case, tumor location was negatively correlated with OS (before PSM in multivariate Cox regression model: HR, 2.43, 95% CI, 1.13–5.22; after PSM in multivariate Cox regression model: HR, 4.32, 95% CI, 1.22–15.26) or DFS (before PSM in multivariate Cox regression model: HR, 4.79, 95% CI, 2.20–10.43; after PSM in multivariate Cox regression model: HR, 9.79, 95% CI, 2.22–43.31), which was also intuitively shown in the Kaplan–Meier survival curves ( Figure 1 ).…”

Section: Resultscontrasting

confidence: 99%

Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study

Feng

Zheng³

et al. 2021

Journal of Oncology

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Importance. Extragastrointestinal stromal tumor (EGIST) is a rare tumor, and its diagnosis and treatment strategy lack clinical guideline and relative literature evidence. In clinical practice, EGIST only misuses the pattern of GIST of diagnosis and treatment. The study hopes to find evidence of the treatment pattern for EGIST. Objective. This study aimed to compare the tumor characteristics and long-term outcomes between EGIST and GIST. The confounding function was applied to improve the result credibility in the case of small sample size. Design, Setting, and Participants. This cohort study enrolled 55 patients with EGIST who underwent surgery and were selected from four high-volume hospitals in China and 221 GIST patients who were collected from one of the four hospitals between January 2006 and September 2017. We used propensity score matching (PSM) and subgroup analysis to compare EGIST with GIST in terms of prognosis. The confounding function was used for sensitivity analysis to reduce unmeasured confounding. Results. We matched 43 patients in each of the GIST and EGIST groups by PSM. We compared EGIST data with GIST data to explore the prognostic factors between them. In the multivariate Cox regression model, tumor location of EGIST was negatively correlated with overall survival (after PSM: HR, 4.32; 95% CI, 1.22–15.26) or disease-free survival (after PSM: HR, 9.79; 95% CI, 2.22–43.31), which was also intuitively shown in the Kaplan–Meier survival curves (all P values < 0.05). In the subgroup analysis, EGIST with high risk factors had a worse prognosis than GIST. In unmeasured confounding analysis, the overall curve tends to show all combinations of c(0) of c(1) up to 2.0, none of which would bring the corrected relative risk to 1 for OS and DFS. Conclusions and Relevance. EGIST was associated with worse prognosis compared with GIST patients, particularly in EGIST patients with high risk factors, while there was a similar prognosis without those high risk factors.

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Section: Resultscontrasting

confidence: 99%

Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study

Feng

Zheng³

et al. 2021

Journal of Oncology

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“…Even more, tumor ulceration was linked to high mitotic rates. 26 In our study, tumor necrosis, tumor ulceration, and high-grade tumors were also more common in GISTs with recurrence.…”

Section: Discussionsupporting

confidence: 58%

Gastrointestinal Stromal Tumors: Recurrence and Survival Analysis of 49 Patients

Çolapkulu

Gunel

Beyazadam

et al. 2023

Middle East J Dig Dis

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Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor originating from the gastrointestinal tract and have a broad spectrum of clinicopathological features affecting disease management regarding the treatment modalities. Methods: A retrospective study of 49 patients who underwent surgery for gastrointestinal tumors between 2008 and 2016 was conducted. Clinical, pathological, and immunohistochemical features of patients with and without recurrence were statistically analyzed.Results: Twenty-nine (59.1%) patients had gastric; 16 (32.6%) had small intestinal; 3 (6.1%) had mesenteric; and 1 (2.2%) had rectal GISTs. Microscopic tumor necrosis and tumor ulceration were also significant for disease recurrence (P = 0.005, P = 0.049). High-risk patients according to Miettinen’s risk classification were more likely to develop a recurrence (P < 0.001). Additionally, high-grade tumors were also a risk factor for recurrence (P < 0.001). Ki-67 levels were available in 40 patients and the mean Ki-67 level was 16.8 in patients with recurrence, which was a significant risk factor in regression analysis (HR: 1.24, 95%, CI: 1.08-1-43). Five-year disease-free survival rates of non-gastric and gastric GISTs were 62.3% and 90%, respectively (P = 0.044).Conclusion: Larger tumors and higher mitotic rates are more likely to develop recurrence. High Ki-67 levels were also associated with recurrence.

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“…It was therefore at high risk of recurrence. Furthermore, the presence of tumour necrosis classifies the tumour as high grade malignant with a significantly higher risk of recurrence compared to non-necrotic tumours [8] , [9] . The treatment of retroperitoneal GISTs is not clearly standardised because of their rarity [2] , [3] .…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal GIST: An exceptional location of a rare tumour. A case report from Ouagadougou and review of the literature

Zongo

Ouédraogo

Koama³

et al. 2021

International Journal of Surgery Case Reports

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Introduction GIST can occur in all segments of the gastrointestinal tract with a predilection for the stomach. Retroperitoneal localization remains exceptional. We report a case to describe our diagnostic and therapeutic approach. Case presentation A 55-year-old patient was admitted with borborygms and a sensation of lumbar swelling for 6 months. He was diabetic and hypertensive. The clinical examination noted a right lumbar mass with perception of bowel sound anterior to the mass, with minimal discomfort and mobility. Ultrasound revealed a hypervascularised, encapsulated, well-limited retroperitoneal tissue mass in contact with the right psoas muscle. Abdomino-pelvic CT scan showed a large, hypervascularized, encapsulated, calcified tissue mass measuring 147 × 106 mm in close contact with the outer edge of the right psoas muscle, suspected of being malignant. MRI noted a suspicious process developed at the expense of the right psoas muscle in its lumbar and iliac portion suggestive of a psoas rhabdomyosarcoma. The patient underwent laparotomy with a retroperitoneal approach by lumbar incision. Histology and immunohistochemistry revealed a GIST expressing CD117. The patient was put on imatinib for 6 months. He is complaint-free after 4 months. Discussion Despite the rarity of retroperitoneal GIST, it should be considered in the presence of any retroperitoneal mass. This will allow for early management. Conclusion Retroperitoneum is an exceptional location for GIST. Surgery remains the mainstay of curative treatment. Adjuvant imatinib reduces the risk of recurrence. The prognosis is usually good.

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Tumor necrosis is significantly associated with reduced recurrence‐free survival after curative resection of gastrointestinal stromal tumors

Cited by 7 publications

References 24 publications

Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study

Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study

Gastrointestinal Stromal Tumors: Recurrence and Survival Analysis of 49 Patients

Retroperitoneal GIST: An exceptional location of a rare tumour. A case report from Ouagadougou and review of the literature

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