Preoperative imaging of gastric GISTs underestimates pathologic tumor size: A retrospective, single institution analysis

Background and Aims. Endoscopic removal of GISTs (gastrointestinal stromal tumors) is recently recognized, but less is known about its efficacy and safety. This study is aimed at assessing the feasibility, clinical efficacy, and safety of the endoscopic removal of gastric GISTs. Patients and Methods. Endoscopic removal (ER) of GISTs was performed in 134 patients at our hospital between January 2015 and January 2019. The clinical features, surgical outcomes, complications, pathological diagnosis, and risk classification were evaluated retrospectively. Results. ER was successful in 131 cases (98%), including 58 by ESD (endoscopic submucosal dissection), 43 by ESE (endoscopic submucosal excavation), 25 by EFTR (endoscopic full-thickness resection), and 5 by STER (submucosal tunneling endoscopic resection). In addition, GISTs of two cases were resected using LECS (laparoscopic and luminal endoscopic cooperative surgery) for the extraluminal and intraluminal growth pattern. The average tumor size was 1.89±1.25 cm (range: 0.5-6.0 cm). Of these patients, 26 cases had a large tumor size (range: 2.0-6.0 cm), and endoscopic removal was successful in all of them. During the procedure, endoclips were used to close the perforation in all cases, without conversion to open surgery. The average length of hospital stay was 5.50±2.15 days (range: 3-10 days). In the risk classification, 106 (79.7%) were of a very low risk, 25 (18.8%) of a low risk, and 2 (1.5%) of a moderate risk. The moderate-risk cases were treated with imatinib mesylate after ER. No recurrence or metastasis was observed during the follow-up period of 23±8 months (range: 3-48 months). Conclusions. The endoscopic treatment is feasible, effective, and safe for gastric GISTs, and individualized choice of approaches is recommended for GISTs.

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Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.91 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 91-91

Author(s):

Sabha Ganai ◽

Mitchell Posner ◽

Vivek N. Prachand ◽

John C. Alverdy ◽

Eugene A. Choi ◽

...

Keyword(s):

Tumor Size ◽

Gastrointestinal Stromal Tumors ◽

Disease Free Survival ◽

Multivisceral Resection ◽

Response To Therapy ◽

Hospital Length Of Stay ◽

Free Survival ◽

Stromal Tumors ◽

Gastric Gists ◽

Disease Free

91 Background: Despite the recent introduction of imatinib and laparoendoscopic techniques to the management of gastric gastrointestinal stromal tumors (GISTs), outcomes remain uncertain in the setting of multivisceral involvement. Methods: We conducted a retrospective review of 69 consecutive patients who underwent resection of gastric GISTs from October 2002 through August 2011. Median follow-up was 19 months (interquartile range [IQR] 4-37). Results: Patients were 51% female, with a mean age of 65 ± 13 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=13) had a longer interval from diagnosis to surgery (7.4 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-3.5] months, p<0.01), greater use of neoadjuvant imatinib (62% vs. 4%, p<0.001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.001) in comparison to gastric-only resections (n=56). Patients were less likely to be managed laparoscopically (8% vs. 71%, p<0.001), had a longer operative time (286 ± 92 vs. 152 ± 65 min, p<0.001), and were less likely to be R0 (69% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (23% vs. 0, p<0.01), they were also more likely to have metastatic disease present (31% vs. 0, p<0.01). Hospital length of stay was greater (median 8 [IQR 7-9] vs. 3 [IQR 2-6] days, p<0.001). There were no significant differences in grade or mitotic index between groups, or in the use of adjuvant imatinib (54% vs. 23%). Overall survival was less in patients undergoing multivisceral resection (63% vs. 86% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median disease-free survival was 50 and 66 months, respectively (p<0.01). Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection was an independent predictor of disease-free survival (p<0.05). Conclusions: Multivisceral involvement is associated with tumors of greater size, and despite an increased use of neoadjuvant imatinib, it is associated with poor outcome for patients with gastric GISTs.

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Prognostic Factors of Patients with Gastric Gastrointestinal Stromal Tumor after Curative Resection: A Retrospective Analysis of 406 Consecutive Cases in a Multicenter Study

European Surgical Research ◽

10.1159/000375234 ◽

2015 ◽

Vol 55 (1-2) ◽

pp. 12-23 ◽

Cited By ~ 2

Author(s):

In-Hwan Kim ◽

Sang-Gyu Kwak ◽

Hyun-Dong Chae

Keyword(s):

Prognostic Factors ◽

Multicenter Study ◽

Tumor Size ◽

Curative Resection ◽

Survival Rates ◽

Disease Free Survival ◽

Free Survival ◽

Gastric Gists ◽

Disease Free

Background/Purpose: Gastric gastrointestinal stromal tumors (GISTs) have a highly variable clinical course, and recurrent disease sometimes develops despite curative surgery. This study was undertaken to investigate the surgical role in treating gastric GISTs and evaluate the clinicopathological features of a large series of patients who underwent curative resection for gastric GISTs to clarify which features were independent prognostic factors. Methods: The clinicopathological data of 406 patients with gastric GISTs who underwent curative resection at 4 university hospitals in Daegu, South Korea, from March 1998 to March 2012 were reviewed. All cases were confirmed as gastric GISTs by immunohistochemical staining, in which CD117 or CD34 was positive. Clinical follow-up was performed periodically, and disease-free survival rates were retrospectively investigated using the medical records. Results: The mean follow-up period was 42.9 months (range: 2-166). There were 11 recurrent patients (2.7%). Due to the small number of recurrences, age, sex and location were controlled using propensity score matching before performing any statistical analysis. Tumor size, mitotic count, NIH classification, and cellularity were judged to be independent prognostic factors for recurrence by univariate analysis. In a multivariate analysis, tumor size and mitotic count were significantly and independently related to recurrence, and tumor size was determined to be the most important prognostic factor for recurrence after curative resection (hazard ratio: 1.204; p < 0.01). Conclusions: The results of this multicenter study demonstrate that disease-free survival rates are good. Tumor size was disclosed as the most important factor for recurrence in gastric GIST patients who underwent radical resection.

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Management of stage I seminomatous germ-cell cancer (SGCC): Results from 4 different risk-adapted strategies in a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16047 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16047-e16047

Author(s):

Mariona Riudavets ◽

Georgia Anguera ◽

Daniela Camacho ◽

Aida Bujosa ◽

Raul Terés ◽

...

Keyword(s):

Tumor Size ◽

Cell Cancer ◽

Disease Free Survival ◽

Rete Testis ◽

Stage I ◽

Treatment Burden ◽

National Guidelines ◽

Single Institution ◽

Significant Difference ◽

Disease Free

e16047 Background: Management of stage I SGCC depends on pathological findings after orchiectomy. Four risk-adapted strategies were sequentially applied in a single institution during a 24-year (yr) period according to national guidelines. Here, we compare treatment burden and outcomes of each of them. Methods: From 1/1994 to 1/2018, 208 patients with stage I SGCC were prospectively included in 4 cohorts. Those without risk criteria underwent close surveillance. Patients received active treatment as follow: Group 1: 1994-1999, only patients with T > pT1 received 2 cycles of carboplatin (CBDCA AUC7 x2); Group 2: 1999-2003, patients received CBDCA AUC7 x2 if either tumor size > 4cm or rete testis invasion; Group 3 : 2004-2009, CBDCA AUC7 x2 if both tumor size > 4cm and rete testis invasion were present; Group 4 : ≥2010, CBDCA AUC7 x1 if either tumor size > 4cm or rete testis invasion. Kaplan Meier and log-rank tests were used to evaluate disease-free survival (DFS), Kruskal-Wallis test to compare amount of chemotherapy received per patient. Results: At a median follow-up of 108 months [range 3-423], 19 (9.1%) relapses had occurred. Global 3 and 5-yr DFS were 92.3% and 90%. All relapsing patients were rendered disease-free with 4 cycles of cisplatin (CDDP) - etoposide. Table 1 summarizes results by cohort: Conclusions: A risk-adapted program provided an overall specific survival of 100%. A clinically significant difference in RR was observed when 1 or 2 courses of CBDCA were given. In our series and considering treatment burden, vascular invasion was a better criteria for patient selection to adjuvant chemotherapy, showing a similar DFS but a lower no of total platinum cycles per patient.[Table: see text]

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Identification of a Preoperative Predictive Factor for Lymph Node Metastasis in Uterine Papillary Serous Carcinoma: Long-term Results From a Single Institution

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000318 ◽

2015 ◽

Vol 25 (1) ◽

pp. 69-74 ◽

Cited By ~ 3

Author(s):

Min-Hyun Baek ◽

Shin-Wha Lee ◽

Jeong-Yeol Park ◽

Daeyeon Kim ◽

Jong-Hyeok Kim ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Predictive Factor ◽

Tumor Size ◽

Long Term Results ◽

Serous Carcinoma ◽

Ca 125 ◽

Preoperative Imaging ◽

Uterine Papillary Serous Carcinoma ◽

Papillary Serous Carcinoma

ObjectiveThe purpose of this study was to identify preoperative clinicopathological predictive factors for lymph node (LN) metastasis in women diagnosed with uterine papillary serous carcinoma (UPSC).MethodsWomen diagnosed with UPSC in our institution from 1997 to 2012 were identified. All patients underwent hysterectomy and bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy. The predictive values of the risk factors for LN metastasis were analyzed using χ2 and multivariate logistic regression analyses.ResultsA total of 94 patients met our study criteria. A CA-125 cutoff of 47.5 IU/mL on the receiver operating characteristic curve provided the best sensitivity and specificity (56.5% vs 90.1%, respectively) for LN metastasis prediction. The sensitivities and specificities of old age (≥60 years), body mass index of 25 kg/m2 or greater, deep myometrial invasion, tumor size greater than 2 cm, tumor size greater than 4 cm, preoperative CA-125 greater than 47.5 IU/mL, LN metastasis on imaging, and extrauterine spread on imaging for the presence of a positive LN were 39.1%, 34.8%, 30.4%, 34.8%, 21.7%, 56.5%, 43.5%, and 52.2%, and 52.1%, 45.1%, 78.9%, 57.7%, 83.1%, 90.1%, 93.0%, and 90.1%, respectively. Preoperative CA-125 (P < 0.001), LN metastasis on preoperative imaging (P < 0.001), and extrauterine spread on preoperative imaging (P = 0.009) were risk factors for LN metastasis on univariate analysis. Multivariate analysis revealed that preoperative CA-125 (P = 0.001) was the only independent risk factor for LN metastasis.ConclusionsPreoperative CA-125 is a preoperative predictive factor for LN metastasis in UPSC.

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Surgical Management and Prognostic Factors Based on 50 Tectal Plate Gliomas

10.21203/rs.3.rs-23446/v1 ◽

2020 ◽

Author(s):

Jie Kang ◽

Chuzhong Li ◽

Peng Zhao ◽

Chunhui Liu ◽

Lei Cao ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Tumor Size ◽

Surgical Procedure ◽

Preoperative Imaging ◽

Low Grade ◽

Large Tumor ◽

Large Tumor Size ◽

Cystic Changes ◽

Tectal Glioma

Abstract BackgroundThe management and prognostic factors of tectal glioma (TG) remain ambiguous, because it is an extremely rare neoplasm that occurs predominantly in the pediatric population. The objective of this study was to evaluate the risk factors for progression-free survival (PFS) in TG patients after ETV operation, elucidate the radiological features of TG, and propose a treatment protocol.MethodsFrom 2002 to 2018, 50 patients that preoperative imaging manifestations were low-grade TGs were treated at our institute. Clinical features, treatments, radiologic findings, biopsies, and pertinent risk factors were evaluated.ResultsA total of 50 patients with a diagnosis of TG were identified. Twenty-six (52%) patients were males. The median age at diagnosis was 11.5 years (range 0.5–19 years). All patients had symptoms related to obstructive hydrocephalus and were treated with endoscopic third ventriculostomy (ETV). After a median follow-up duration of 59 months (range 11.0–208.0 months), progression occurred in six patients (12%), with a median PFS time of 18.0 months (range 4.0–56.0 months). Twelve patients (24%) underwent a biopsy, one patient (8.3%) was diagnosed with anaplastic oligodendroglioma, one patient (8.3%) was diagnosed with astrocytoma (WHO grade II-III), five patients (41.7%) were diagnosed with pilocytic astrocytoma, and the type of tumor could not be confirmed in five patients (41.7%) due to the small amount of tumor sample, thus, these patients were diagnosed with gliosis. PFS rates at 1 and 5 years were 91.2% ± 4.2% and 84.9% ± 5.9%, respectively. A multivariate model demonstrated that a large tumor size and cystic changes are risk factors for progression.ConclusionETV has been uniformly successful in the management of hydrocephalus caused by TG. A large tumor size and cystic changes are risk factors for progression. Under the condition of safety, a biopsy should be performed. For patients with low-grade TG, ETV is often the only surgical procedure that most patients require.HighlightsTectal gliomas are generally low-grade gliomas with a favorable prognosis.The only surgical procedure that most patients with tectal glioma require is ETV.Under the condition of safety, neuroendoscopy for a pathological diagnosis should be performed.A large tumor size and cystic changes are risk factors for progression.

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P.04.5 PROGNOSIS OF GASTRIC GISTS BASED ON TUMOR SIZE

Digestive and Liver Disease ◽

10.1016/s1590-8658(16)30186-4 ◽

2016 ◽

Vol 48 ◽

pp. e144

Author(s):

T. Togliani ◽

N. Mantovani ◽

E. Vitetta ◽

A. Savioli ◽

L. Troiano ◽

...

Keyword(s):

Tumor Size ◽

Gastric Gists

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Sarcoma tumor size (T) staging: Are radiology or pathology measurements more appropriate?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22522 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22522-e22522

Author(s):

Angela Pang ◽

Mariana Carbini ◽

Elizabeth Demicco ◽

Robert G. Maki

Keyword(s):

Tumor Size ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Preoperative Imaging ◽

3D Measurements ◽

T Stage ◽

Irregular Shapes ◽

Tumor Measurements ◽

2D And 3D ◽

Radiology And Pathology

e22522 Background: In the AJCC version 7 TNMG staging of soft tissue sarcomas (STS), the longest dimension (1D) of the primary tumor at pathology analysis is the gold standard for tumor size (T) staging. However, measurements may differ between scans and actual tissue measurement, due to tissue elasticity, deformation, and/or formalin fixation. Thus, tumor size may change compared to preoperative imaging. Should STS T stage be defined by imaging or by direct tumor measurement? We examined the variability of the measurements between radiology and pathology data, examining 1D, cross sectional area (2D), and tumor volume (3D) to assign a T stage. Methods: We reviewed all patients (pts) with extremity STS who had surgery at Mt Sinai Hospital New York (2010-2015). MRI or CT and resected gross tumor measurements were available for 79 pts. After eliminating 10 samples with grossly irregular shapes and 11 samples with incomplete data, 58 tumors had complete 3D measurements. We calculated Pearson correlation coefficients for paired variables (radiology vs pathology size in 1D, 2D and 3D). Results: Imaging measures correlated well with direct tumor measurements. Pearson correlation coefficients for 1D, 2D and 3D measurements were 0.93, 0.72 and 0.78, respectively (all p < 0.01). The SEM (radiology/pathology size) = 0.13, i.e. 13% for 1D measurements. Thus, T stage could be incorrectly assigned in up to 13% of samples near 5 cm in size; this proportion decreases the further the tumor is from the 5 cm cutoff. Conclusions: As shown previously in the rationale for RECIST, 1D measures provide the smallest variance between radiology and pathology. The situation is made more complex in AJCC version 8, with four T categories. It remains unclear how to stage the 10-15% of primary STS with irregular shapes. These data support the use of nomograms for risk assessment rather than using bins created by the AJCC tumor staging system. 3D tumor volumes, if used at all, may play a greater role when assessing therapy responses or contending with tumors of irregular shape, rather than for routine STS staging.

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