Gastrointestinal Stromal Tumors: A Single Center Experience

Gastrointestinal Stromal Tumors: A Single Center Experience

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the gastrointestinal (GI) tract. The aim of this retrospective study was to explore the characteristics, prognostic factors, and treatment results of GIST cases. METHODS Clinical and pathological data of 35 GIST patients at our center between 2002 and 2015 were reviewed. RESULTS Total of 18 (51.4%) were women and 17 (48.6%) were men, with median age of 54 years. Common site of tumor was stomach (48.6%). Abdominal pain (37.1%) was common clinical symptom. Risk group distribution was 8.6% low, 31.4% intermediate, and 60% high-risk cases. Mean follow-up period of the patients was 34 months. Low-risk GIST can be treated with surgery alone. Recurrence was observed in only 1 of 10 patients who received adjuvant treatment. All 6 patients in whom metastasis was determined were in high-risk group, and 4 of them had liver metastasis. Metastasis was not detected in any of the patients who had 10 mitoses per 50 HPF, metastasis was determined. Metastasis did not correlate with site or size of tumor, but was related to high mitotic rate (p=0.015). Median overall survival of the patients was 79 months. CONCLUSION Low-risk GIST can be treated with surgery alone. Imatinib therapy significantly improves survival of high-risk or advanced-stage GIST patients. Metastasis did not correlate with site or size of tumor, but correlation with high mitotic rate was observed

___

  • 1. Kindblom LG, Remotti HE, Aldenborg F, MeisKindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152(5):1259–69.
  • 2. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer 2002;38:39–51.
  • 3. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006;130(10):1466–78.
  • 4. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998;279(5350):577–80.
  • 5. Heinrich MC, Corless CL, Demetri GD, Blanke CD, von Mehren M, Joensuu H, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol 2003;21(23):4342– 9.
  • 6. de Silva CM, Reid R. Gastrointestinal stromal tumors (GIST): C-kit mutations, CD117 expression, differential diagnosis and targeted cancer therapy with Imatinib. Pathol Oncol Res 2003;9(1):13–9.
  • 7. Roberts PJ, Eisenberg B. Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 2002;38 Suppl 5:37–8.
  • 8. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruf JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231(1):51–8.
  • 9. Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schütte J, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA 2012;307(12):1265–72.
  • 10.Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G. Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 2002;33(5):466–77.
  • 11.Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33(5):459–65.
  • 12.Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23(2):70–83.
  • 13.Rutkowski P, Bylina E, Wozniak A, Nowecki ZI, Osuch C, Matlok M, et al. Validation of the Joensuu risk criteria for primary resectable gastrointestinal stromal tumour - the impact of tumour rupture on patient outcomes. Eur J Surg Oncol 2011;37(10):890–6.
  • 14.Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008;39(10):1411–9.
  • 15.Seker M, Sevinc A, Yildiz R, Cihan S, Kaplan MA, Gokdurnali A, et al. Prognostic factors in gastrointestinal stromal tumors: multicenter experience of 333 cases from Turkey. Hepatogastroenterology 2013;60(124):768–75.
  • 16.Bhalgami R, Manish K, Patil P, Mehta S, Mohandas KM. Clinicopathological study of 113 gastrointestinal stromal tumors. Indian J Gastroenterol 2013;32(1):22–7.
  • 17.Sturgeon C, Cheifec G, Espat NJ. Gastrointestinal stromal tumors: a spectrum of disease. Surg Oncol 2003;12:21–6.
  • 18.Wong NA, Young R, Malcomson RD, Nayar AG, Jamieson LA, Save VE, et al. Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach. Histopathology 2003;43(2):118– 26.
  • 19.Cao H, Zhang Y, Wang M, Shen DP, Sheng ZY, Ni XZ, et al. Prognostic analysis of patients with gastrointestinal stromal tumors: a single unit experience with surgical treatment of primary disease. Chin Med J(Engl) 2010;123(2):131–6.
  • 20.Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer 2003;6(1):39–48.
  • 21.Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009;373(9669):1097– 104.
  • 22.Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 2004;364(9440):1127–34.