ORIGINAL RESEARCH ARTICLE
Effect of clinical and pathological features of gastrointestinal stromal tumors on overall survival and prognosis: Single center experience
Received Date : 05 Jul 2019
Accepted Date : 19 Oct 2019
Available Online : 31 Oct 2019
Elif Merev a, Irfan Cicin b
a Karadeniz Technical University, School of Medicine, Medical Oncology Department, Turkey
b Trakya University, School of Medicine, Medical Oncology Department, Turkey
Doi: 10.1016/j.jons.2019.10.003 - Article's Language: EN
J Oncol Sci 5 (2019) 73-79
ABSTRACT
Aim: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the
gastrointestinal tract.We aimed to evaluate the clinicopathological features of the patients in Thrace and
improve our management.
Material and Method: In this retrospective study, 68 patients with a diagnosis of GIST referred to Trakya
University Medical School Hospital between 1997 and 2015 were evaluated.
Results: The most common symptom was abdominal pain (38.2%) and the location was small-intestine
(42.6%). Large masses had higher metastasis and relapse rate. The mean tumor size with relapse was
11.8 ± 3.8 cm meanwhile it was 6.5 ± 3.0 cm in non-relapsed patients (p ¼ 0.01). The mean size of the
tumor was 13.5 ± 4.4 in the metastatic group although this data was 8.8 ± 4.7 cm in the non-metastatic
group (p ¼ 0.01). With necrotic tumors, mitotic rate and size were higher. The mean mitosis count was
21.0 ± 3.6 in necrotic tumors and 7.2 ± 9.9 in non-necrotic tumors (p ¼ 0.005). The mean size was
10.8 ± 5.0 cm in necrotic tumors and 5.6 ± 3.0 cm in non-necrotic tumors (p ¼ 0.009). According to AFIP
criteria, most of the patients were in the high-risk group (57.4%). Overall survival (OS) was longer in nonsmokers
and non-drinkers. Median OS was 80.16 months in non-smoker group (95% CI, 27.83e132.49)
and 24.64 months (95% CI, 15.49e33.78) in the smoker group (p ¼ 0.001). The median OS was 80.09
months in the non-drinker group (95% CI, 13.99e146.20) and 24.64 months (95% CI, 13.18e36.10) in
drinker group (p ¼ 0.05). Median OS in stomach GIST was 41.39 months, in small-intestine were 80.09
months and in the colon were 35.68 months (p ¼ 0.032). Patients underwent surgery had longer overallsurvival.
Median OS was 80.09 months in patients undergone surgery and 16.98 months in patients had
not been operated (p ¼ 0.001). Overall survival was longer in GIST with mitotic rate <5/50HPF than with
>5/50HPF. Median OS was 80.16 months in patients who had less than 5 mitosis and 39.22 months in
higher mitotic rate (95% CI, 31.58e46.87) (p ¼ 0.034). Overall survival was shorter in GIST with Ki-67 > 5%
than with 5%>. Median OS was 80.16 months (95% CI, 28.80e49.65) in <5% and 39.22 months (95% CI,
28.80e49.65) in 5% Ki-67 (p ¼ 0.004).
Conclusions: The most important factors about the survival and prognosis of GIST are location, size,
mitotic rate, Ki-67, necrosis and surgery status. Using tobacco/alcohol may be related to survival. This
study should be further investigated with extensive data.
Keywords: GIST; Overall-survival; Prognosis
REFERENCES
- Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006;130:1466e1478.
- Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003;299:708e710. [Crossref] [PubMed]
- Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100:162e168. [Crossref] [PubMed]
- Miettinen M, Lasota J. Gastrointestinal stromal tumorsd definition, clinical, histological, immunohistochemical and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1e12. [Crossref] [PubMed]
- Corless CL. Heinrich MC Molecular pathobiology of gastrointestinal stromal sarcomas. Annu Rev Pathol. 2008;3:557e586. [Crossref] [PubMed]
- Chen T, Qiou H, Feng X, et al. Comparison of modified NIH and AFIP riskstratification criteria for gastrointestinal stromal tumors: A multicenter retrospective study. Chinese Journal of Gastrointestinal Surgery. 2017;20:1020e1024.
- Joensuu H, Eriksson M, Sundby Hall K, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. J Am Med Assoc. 2012;307:1265e1272. [Crossref] [PubMed]
- Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw. 2010;8:1e41. [Crossref] [PubMed]
- Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet. 2006;368:1329e1338. [Crossref]
- Demetri GD, Reichardt P, Kang YK, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381:295e302.
- Seker M, Sevinc A, Yıldız R, et al. Prognostic factors in gastrointestinal stromal tumors: multicenter experience of 333 cases from Turkey. Hepatogastroenterology. 2013;60:768e775.
- Zhang XH, He Yl, Zhan WH, et al. Diagnosis and treatment of gastrointestinal stromal tumors: report of 135 cases. Chin J Gastrointestinal Surg (Chin). 2007;10:17e20.
- Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459e465. [Crossref] [PubMed]
- Engin G, Asoglu O, Kapran Y, et al. A gastrointestinal stromal tumor with mesenteric and retroperitoneal invasion. World J Surg Oncol. 2007;5:121. [Crossref] [PubMed] [PMC]
- Jin SS, Jeong HS, Noh HJ, et al. Gastrointestinal stromal tumor solitary distant recurrence in the left brachialis muscle. World J Gastroenterol. 2015;21: 6404e6408. [Crossref] [PubMed] [PMC]
- Hirota S, Isozaki K, Moriyoma Y, et al. Gain of function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577e580. [Crossref] [PubMed]
- Espinosa L, Lee CH, Kim MK, et al. A novel monoclonal antibody against DOG 1 is a sensitive and specific marker for gastrointestinal stromal tumors. Am J Surg Pathol. 2008;32:210e218. [Crossref] [PubMed]
- Pidhorecky I, Cheney RT, Kraybill WG, et al. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. 2000;7: 705e712. [Crossref] [PubMed]
- Joensuu H, Vehtari A, Riihimaki J, et al. Risk of recurrence of gastrointestinal stromal tumor after surgery: an analysis of pooled populationbased cohorts. Lancet Oncol. 2012;13:265e274. [Crossref]
- Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005;29:52e68. [Crossref] [PubMed]
- Miettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejenum and ileum: a clinicopathologic, immunohistochemical and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J Surg Pathol. 2006;30:477e489. [Crossref] [PubMed]
- Li Y, Tan B, Wu H, et al. The risk factors about prognosis of 142 GIST patients with recurrence or metastasis: a retrospective study of single centre in Northern China. J Buon. 2018;23:1855e1861.
- Zheng J, Li R, Qiu H, et al. Tumor necrosis and >20 mitoses per 50 high-power fields can distinguish 'very high-risk' and 'highest-risk' within 'high-risk' gastric gastrointestinal stromal tumor. Future Oncol. 2018;14:621e629. [Crossref] [PubMed] [PMC]
- Neto RA, Logullo AF, Stavale JN, et al. Ki-67 expression score correlates to survival rate in gastrointestinal stromal tumors (GIST). Acta Cir Bras. 2012;27: 315e321. [Crossref] [PubMed]
- Belev B, Brcic I, Prejac J, et al. Role of Ki-67 as a prognostic factor in gastrointestinal stromal tumors. World J Gastroenterol. 2013;19:523e527. [Crossref] [PubMed] [PMC]
- Basilio-de-Oliveira RP, Nunes Pannain VL. Prognostic angiogenic markers (endoglin, VEGF, CD31) and tumor cell proliferation (Ki67) for gastrointestinal stromal tumors. World J Gastroenterol. 2015;21:6924e6930. [Crossref] [PubMed] [PMC]
- Hou YY, Lu SH, Zhou Y, et al. Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors. Mod Pathol. 2009;22:556e569. [Crossref] [PubMed]
- Oliveira RP, Portari Filho PE, Iglesias AC, et al. Comparative study of the different degrees of risk of gastrointestinal stromal tumor. Rev Col Bras Cir. 2015;42:32e36. [Crossref] [PubMed]
- Miettinen M, El-Rifai W, Sobin LH, et al. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol. 2002;33: 478e483. [Crossref] [PubMed]
- Emory TS, Sobin LH, Lukes L, et al. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999;23: 82e87. [Crossref] [PubMed]
- Nakamura N, Yamamoto H, Yao T, et al. Prognostic significance of expressions of cell-cycle regulatory proteins in gastrointestinal stromal tumor and the relevance of the risk grade. Hum Pathol. 2005;36:828e837. [Crossref] [PubMed]
- Bertolini V, Chiaravalli AM, Klersy C, et al. Gastrointestinal stromal tumorsdfrequency, malignancy, and new prognostic factors: the experience of a single institution. Pathol Res Pract. 2008;204:219e233. [Crossref] [PubMed]
- Kukar M, Kapil A, Papenfuss W, et al. Gastrointestinal stromal tumors (GISTs) at uncommon locations: a large population based analysis. J Surg Oncol. 2015;111:696e701. [Crossref] [PubMed]
- van Erp N, Gelderblom H, van Glabbeke M, et al. Effect of cigarette smoking on imatinib in patients in the soft tissue and bone sarcoma group of the EORTC. Clin Cancer Res. 2008;14:8308e8313. [Crossref] [PubMed]
- Sakin A, Can O, Arıcı S, et al. Factors affecting disease-free survival in operated nonmetastatic gastrointestinal stromal tumors. J Surg Res. 2019;241:170e177. [Crossref] [PubMed]
- Cavnar MJ, Seier K, Curtin C, et al. Outcome of 1000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre and post-imatinib eras. Ann Surg. 2019;4:1e11. https://doi: 10.1097/SLA.0000000000003277. [Crossref] [PubMed]