P.04.5 PROGNOSIS OF GASTRIC GISTS BASED ON TUMOR SIZE

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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Correlation of endoscopic ultrasonography features with mitotic index in 2–5 cm gastric gastrointestinal stromal tumors

Digestive Diseases ◽

10.1159/000516250 ◽

2021 ◽

Author(s):

Gulseren Seven ◽

Dilek Sema Arici ◽

Hakan Senturk

Keyword(s):

Mitotic Index ◽

Tumor Size ◽

Univariate Analysis ◽

Management Strategies ◽

Tumor Location ◽

Growth Patterns ◽

Gastric Gists ◽

Index Group ◽

Risk Of Malignancy ◽

Malignancy Potential

Background: Predicting the malignancy potential of gastrointestinal stromal tumor (GIST) before resection could improve patient management strategies, as gastric GISTs with a low malignancy potential can be safely treated endoscopically, but surgical resection is required for those tumors with a high malignancy potential. This study aimed to evaluate endoscopic ultrasound (EUS) features of 2–5 cm gastric GISTs that might be used to predict their mitotic index using surgical specimens as the gold standard. Patients and Methods: Forty-nine patients (30 females and 19 males; mean age 55.1 ± 12.7 years) who underwent EUS examinations, followed by surgical resections of 2–5 cm gastric GISTs were retrospectively reviewed. Results: The mean tumor size was 3.44 ± 0.97 cm (range 2.1–5.0 cm). A univariate analysis revealed no significant differences in age, sex, and tumor location in the low mitotic index and high mitotic index groups (all P > 0.05). In terms of EUS features, there were no significant differences in the mitotic indexes with respect to the shape, surface lobulation, border regularity, echogenicity, homogeneity, growth patterns, presence of mucosal ulceration, hyperechogenic foci, anechoic spaces, and hypoechoic halos (all P > 0.05). However, the tumor size was larger in the high mitotic index group than in the low mitotic index group (3.97 ± 1.05 vs. 3.27 ± 0.9 cm, P = 0.03). Conclusion: Conventional EUS features are not reliable for predicting the mitotic index of 2–5 cm gastric GISTs. Further modalities for predicting the mitotic index are needed to prevent unnecessary surgical resections in patients with a low risk of malignancy.

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Clinicopathological Features and Clinical Outcomes of Primary Hepatic Gastrointestinal Stromal Tumors: Evaluation of a Pooled Case Series

10.21203/rs.3.rs-66778/v1 ◽

2020 ◽

Author(s):

Xing Xu ◽

Guoliang Zheng ◽

Zhichao Zheng

Keyword(s):

High Risk ◽

Mitotic Index ◽

Tumor Size ◽

Gastrointestinal Stromal Tumors ◽

Multivariable Analysis ◽

Case Series ◽

Risk Classification ◽

Clinicopathological Features ◽

Stromal Tumors ◽

Gastric Gists

Abstract Background: Due to the extremely rare incidence, data of clinicopathological features and prognosis of primary hepatic gastrointestinal stromal tumors (GISTs) is limited. Methods: 36 cases of hepatic GISTs were from the literature, PUBMED, EMBASE, China National Knowledge Infrastructure and WANFANG DATA, and 1 case came from our center. Clinicopathological features and outcomes were analyzed between 37 hepatic GISTs and 254 gastric GISTs from our center. Results: A majority of hepatic GISTs exceeded 5 cm (83.7%), displayed mixed density (69.4%) and spindle morphology (74.2%) and were classified as high risk (91.4%). Larger tumors of hepatic GISTs were likely to display mixed lesion and tumors with mixed lesion were prone to be classified as high risk. In comparisons to gastric GISTs, hepatic GISTs differed from gastric GISTs in tumor size, main symptoms, histologic type, mitotic index, CD34 expression, NIH risk classification. In patients with hepatic GISTs, 5-year DFS and DSS rates were 19.4% and 53.7%, which were worse than that of gastric GISTs (P＜ 0.001), especially for those with tumor size exceeding 5 cm or mitotic indices exceeding 5/50 HPF (P < 0.001). Multivariable analysis showed location and NIH risk classification were independent prognostic factors for DFS in patients with GISTs, and size and location were significantly associated with DSS. Conclusions: Hepatic GISTs distinguished from gastric GISTs in respect to clinicopathological features and outcomes. Mitotic index exceeding 5/50 HPF or tumor size exceeding 5 cm may be important factor to distinguish hepatic GISTs from gastric GISTs in DFS and DSS.

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Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.10090 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 10090-10090

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 ◽

Adjuvant Imatinib ◽

Free Survival ◽

Stromal Tumors ◽

Gastric Gists ◽

Disease Free

10090 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 73 consecutive patients who underwent resection of gastric GISTs from October 2002 through December 2011. Median follow-up was 22 months (interquartile range [IQR] 6-37). Results: Patients were 51% female, with a mean age of 65 ± 12 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=14) had a longer interval from diagnosis to surgery (7.3 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-4.2] months, p<0.01), greater use of neoadjuvant imatinib (64% vs. 3%, p<0.0001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.0001) in comparison to gastric-only resections (n=59). Patients were less likely to be managed laparoscopically (7% vs. 71%, p<0.0001), had a longer operative time (310 ± 117 vs. 145 ± 62 min, p<0.0001), and were less likely to be R0 (71% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (29% vs. 0, p<0.001), they were also more likely to have metastatic disease present (29% vs. 0, p<0.001). Hospital length of stay was greater (median 8 [IQR 6-9] vs. 3 [IQR 2-6] days, p<0.0001). There were no significant differences in grade or mitotic index between groups. There was greater use of adjuvant imatinib (64% vs. 25%, p<0.05). Overall survival was less in patients undergoing multivisceral resection (64% vs. 87% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median overall and disease-free survival were 43 and 22 months after multivisceral resection for gastric GISTs. Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection and use of adjuvant imatinib were both independent predictors 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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