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

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.

scholarly journals Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Yingjie Guo ◽  
Xue Jing ◽  
Jian Zhang ◽  
Xueli Ding ◽  
Xiaoyu Li ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Average Length ◽  
Risk Classification ◽  
Low Risk ◽  
Efficacy And Safety ◽  
Endoscopic Removal ◽  
Moderate Risk ◽  
Stromal Tumors ◽  
Gastric Gists

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.

Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

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.

scholarly journals MRI-Based Radiomics Models for Predicting Risk Classification of Gastrointestinal Stromal Tumors

2021 ◽  
Vol 11 ◽  
Author(s):  
Haijia Mao ◽  
Bingqian Zhang ◽  
Mingyue Zou ◽  
Yanan Huang ◽  
Liming Yang ◽  
...  
Keyword(s):  
High Risk ◽  
Random Forest ◽  
Gastrointestinal Stromal Tumors ◽  
Roc Curves ◽  
Risk Classification ◽  
Low Risk ◽  
Intermediate Risk ◽  
Stromal Tumors ◽  
Mr Sequences

BackgroundWe conduct a study in developing and validating four MRI-based radiomics models to preoperatively predict the risk classification of gastrointestinal stromal tumors (GISTs).MethodsForty-one patients (low-risk = 17, intermediate-risk = 13, high-risk = 11) underwent MRI before surgery between September 2013 and March 2019 in this retrospective study. The Kruskal–Wallis test with Bonferonni correction and variance threshold was used to select appropriate features, and the Random Forest model (three classification model) was used to select features among the high-risk, intermediate-risk, and low-risk of GISTs. The predictive performance of the models built by the Random Forest was estimated by a 5-fold cross validation (5FCV). Their performance was estimated using the receiver operating characteristic (ROC) curve, summarized as the area under the ROC curve (AUC). Area under the curve (AUC), accuracy, sensitivity, and specificity for risk classification were reported. Linear discriminant analysis (LDA) was used to assess the discriminative ability of these radiomics models.ResultsThe high-risk, intermediate-risk, and low-risk of GISTs were well classified by radiomics models, the micro-average of ROC curves was 0.85, 0.81, 0.87 and 0.94 for T1WI, T2WI, ADC and combined three MR sequences. And ROC curves achieved excellent AUCs for T1WI (0.85, 0.75 and 0.82), T2WI (0.69, 0.78 and 0.78), ADC (0.85, 0.77 and 0.80) and combined three MR sequences (0.96, 0.92, 0.81) for the diagnosis of high-risk, intermediate-risk, and low-risk of GISTs, respectively. In addition, LDA demonstrated the different risk of GISTs were correctly classified by radiomics analysis (61.0% for T1WI, 70.7% for T2WI, 83.3% for ADC, and 78.9% for the combined three MR sequences).ConclusionsRadiomics models based on a single sequence and combined three MR sequences can be a noninvasive method to evaluate the risk classification of GISTs, which may help the treatment of GISTs patients in the future.

scholarly journals The prognostic role of Controlling Nutritional Status (CONUT) scores in patients with gastrointestinal stromal tumors

2019 ◽  
Author(s):  
Weili Yang ◽  
Chunhui Shou ◽  
Jiren Yu ◽  
Qing Zhang ◽  
Xiaosun Liu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Nutritional Status ◽  
Mitotic Index ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Rank Test ◽  
Primary Tumor Site ◽  
Stromal Tumors ◽  
Common Location ◽  
Conut Score

Abstract Background: The Controlling Nutritional Status (CONUT) score is associated with the postoperative outcomes in various types of tumors. The relationship between the CONUT score and prognosis in patients with gastrointestinal stromal tumors (GISTs) needs to be clarified. Methods: Patients with completely resected primary GISTs in the absence of imatinib adjuvant therapy were included. Recurrence-free survival (RFS) was estimated with the Kaplan-Meier method and compared using log-rank test. Prognostic factors were compared using a Cox proportional hazards model. Results: A total of 455 patients were included. The median age was 57 years and 222 (48.8%) patients were male. The most common location was stomach (n= 219, 48.1%), the median tumor size was 4.5 cm (range 0.4-40.0) and the median mitotic index was 2/50 HPFs (range 0-200). Recurrence/metastasis developed in 92 (20.2%) patients. Patients were assigned to three groups: 219 (48.1%) were in normal nutrition group (CONUT=0-1), 196 (43.1%) were in light undernutrition group (CONUT=2-4) and 40 (8.8%) were in moderate-severe undernutrition group (CONUT≥5). Primary tumor site, tumor size, mitotic index, tumor rupture and CONUT score were independent prognostic factors for RFS using multivariate analysis (p<0.05). Conclusions: The CONUT score was an independent prognostic factor for patients with completely resected GIST.

scholarly journals Gastrointestinal stromal tumors: Microscopic and immunihistochemical features

2007 ◽  
Vol 64 (9) ◽  
pp. 597-603
Author(s):  
Gorana Rancic ◽  
Vuka Katic ◽  
Ljubinka Jankovic-Velickovic ◽  
Milan Rancic
Keyword(s):  
Mitotic Index ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Malignant Tumors ◽  
Smooth Muscle Actin ◽  
Biological Behavior ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
S 100 ◽  
Cells Of Cajal

Background/Aim. Gastrointestinal (GI) stromal tumors (GIST) are the most common mesenchymal tumors of GI tract. The most frequent localization is gastric (60-70%) followed by intestinal localization (20-30%). The histogenesis, classification, diagnostic criteria and biological behavior of GIST are still discussable. Gastrointestinal stromal tumors are thought to originate from interstitial pacemaker intestinal cells of Cajal. Histologic appearance of a GIST is complicated and biologic potential unpredictable. The aim of of tha study was to investigate anatomic localization , the size of the tumor, incapsulation, microscopic and immunohistochemical characteristics. Methods. The study involved 21 GIST taken by a complete resection in the period from 1994-2006. The analysed parameters were the localization, size, microscopic (mitotic index, nectosis, bleeding, invasivity) and immunohistochemical characteristics (CD117 (ckit), CD34, desmin, vimentin, smooth muscle actin and s- 100 protein expression. Results. Gastrointestinal stromal tumors (n=21) size varied from 10-150 mm were most frequently gastric localised with predominance of malignant tumors (85.72%). Most GIST were comprised of a uniform spindle cell population, but some were dominated by epitheloid cells. Eosinophilic cells stained CD117, CD34 and vimentin positively, were usually arranged in fascicles with the presence of skeinoid fibers. Positive correlation of biologic potential and tumor size, haemorrhagia and mitotic index were found, so as negative correlation of biologic potential and incapsulation. Conclusion. The above results, a specially localization, tumor size, mitotic index, CD117, CD34 and vimentin positivity, may be helpful for setting of a widespread criteria for diagnostic and differential diagnosis of GIST and their use in practice and therapy. .

scholarly journals C-Reactive Protein/Albumin Ratio Is a Powerful Prognostic Indicator for Survival in Surgically Resected Gastrointestinal Stromal Tumors: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Xianglong Cao ◽  
Jian Cui ◽  
Zijian Li ◽  
Gang Zhao
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Cox Regression ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Risk Classification ◽  
C Reactive Protein ◽  
Term Survival ◽  
Albumin Ratio ◽  
Stromal Tumors ◽  
Reactive Protein

Abstract Background Systemic inflammation and malnutrition may promote tumor progression. C-reactive protein/albumin ratio (CAR) is linked with poor long-term survival of several malignant tumors.Purpose To explore the predictive value of CAR in gastrointestinal stromal tumors (GISTs).Methods A retrospective study was conducted on 325 patients with GIST who underwent radical surgery from 2009 to 2018. The cut-off point of CAR was set using X-tile software. Kaplan-Meier method and multivariate Cox regression model were used to study the prognostic value of CAR. The time-dependent receiver operating characteristic curve(tROC) was drawn, and the prognostic accuracy of CAR, Glasgow prognosis score (GPS), and NIH risk classification was compared by the area under the curve (AUC).Results The best cut-off point of CAR was 0.55. Increased CAR was associated with the location of the lower digestive tract, larger tumor size, higher mitotic index, higher NIH risk classification, lower ALB, higher CRP, and higher GPS (all p<0.05). Multivariable analysis revealed that CAR (hazard ratio [HR] 2.598, 95% confidence interval [CI] 1.385-4.874; p=0.003) was an independent predictor of overall survival. Additionally, the AUC of CAR was lower than that of NIH risk classification at 2-year (0.601vs. 0.775, p=0.002) and 5-year (0.629 vs. 0.735, p=0.069). However, the AUC of NIH risk classification was significantly increased (2-year OS 0.801, p=0.251; 5-year OS 0.777, p=0.011) when it was combined with CAR.Conclusions CAR is a new independent predictor of poor survival in patients with GIST. CAR combined with NIH risk classification can effectively improve the performance of prognosis prediction.

scholarly journals Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

2021 ◽  
Vol 10 (19) ◽  
pp. 4459
Author(s):  
Nikolaos Vassos ◽  
Aristotelis Perrakis ◽  
Werner Hohenberger ◽  
Roland S. Croner
Keyword(s):  
High Risk ◽  
Surgical Approach ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Tumor Biology ◽  
Disease Free Survival ◽  
Extended Resection ◽  
Stromal Tumors ◽  
Duodenal Gist ◽  
Increased Risk

Background: Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. Methods: We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12–140). Results: A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42–77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5–13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. Conclusion: The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.

scholarly journals Clinicopathological features and prognosis of colonic gastrointestinal stromal tumors: evaluation of a pooled case series

Oncotarget ◽  
2016 ◽  
Vol 7 (26) ◽  
pp. 40735-40745 ◽  
Author(s):  
Fan Feng ◽  
Yangzi Tian ◽  
Zhen Liu ◽  
Guanghui Xu ◽  
Shushang Liu ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Case Series ◽  
Clinicopathological Features ◽  
Stromal Tumors

Clinicopathological Features and Prognosis of Gastrointestinal Stromal Tumor Located in the Jejunum and Ileum

2018 ◽  
Vol 36 (2) ◽  
pp. 153-157 ◽  
Author(s):  
Fan Feng ◽  
Fei Wang ◽  
Qiao Wang ◽  
Gaozan Zheng ◽  
Guanghui Xu ◽  
...  
Keyword(s):  
Survival Data ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Clinicopathological Characteristics ◽  
Clinicopathological Features ◽  
Seer Database ◽  
Stromal Tumors ◽  
Median Tumor Size ◽  
Background Data ◽  
Disease Specific

Background: Data about the clinicopathological features and prognosis of gastrointestinal stromal tumors (GISTs) located in jejunum and ileum are lacking. The present study aims to investigate the features and prognosis of jejunal and ileal GISTs based on the Surveillance, Epidemiology, and End Results (SEER) database. Patients and Methods: Cases of jejunal and ileal GISTs were extracted from SEER database. Clinicopathological characteristics and survival data of patients were recorded. The clinicopathological features and prognosis of patients were analyzed. Results: There were 399 male (56.8%) and 303 female (43.2%). The median age was 60 years (17–96). Four hundred and seventy-two tumors were located in the jejunum (67.2%) and 230 tumors in the ileum (32.8%). The median tumor size was 7.0 cm (0.5–90). The 5-, 10-, and 20-year disease specific survival (DSS) was 84.4, 71.2, and 54.2% respectively. Clinicopathological features were comparable between tumors located in the jejunum and ileum (all p > 0.05) except gender and tumor size (both p < 0.05). Jejunal GISTs, rather than ileal GISTs (p = 0.043), were commonly found in the males. The tumor size of jejunal GISTs was smaller than that of ileal GISTs (p = 0.010). The DSS of jejunal GISTs was comparable to that of ileal GISTs (p = 0.269). Conclusions: Jejunal GISTs were more common than ileal GISTs. The prognosis was comparable between jejunal and ileal GISTs.

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