Top

World Journal of Surgery

Published in:

01-11-2008

Surgical Margin Status and Prognosis of Gastrointestinal Stromal Tumor

Authors: António M. Gouveia, Amadeu P. Pimenta, Ana F. Capelinha, Dionísio de la Cruz, Paula Silva, José M. Lopes

Published in: World Journal of Surgery | Issue 11/2008

Abstract

Background

Surgery is the best treatment for primary GIST and may be curative, but resection extension/completeness impact on the prognosis remains controversial. The authors aim was to evaluate the clinicopathological (CP) parameters and surgical margins status influence on GIST patients’ outcome.

Materials and methods

The study evaluated 113 consecutive patients with sporadic GIST; the influence of CP parameters on recurrence-free survival (RFS) and disease-specific survival (DSS) was determined by univariate analysis (UA) and multivariate analysis (MA).

Results

Of 104 cases, macroscopically complete resection was achieved in 96: R0 surgical margin status in 78 and R1 in 18. Recurrence rates (12.5%) were significantly lower in R0 (9.0%) than in R1 (27.8%). Tumor >10 cm, mitotic count >5/50 high power field (HPF), and high-risk GIST predicted poor RFS and DSS (UA). Disease-specific survival was significantly shorter after macroscopic incomplete (R2) resection, for mixed cellular morphology, and in tumors with necrosis (UA). High-risk GIST (p = 0.016) and R2 resection (p = 0.013) predicted poor DSS of patients (MA).

Conclusions

High risk and positive macroscopic surgical margin status are parameters associated with poor disease-specific survival in GIST patients.

Miettinen M, Blay JY, Sobin LH (2000) Mesenchymal tumors of the stomach. In: Hamilton SR, Aaltonen LA (eds) Pathology and genetics of tumors of the digestive system. Lyon, France, IARC Press, pp 62–65

Nilsson B, Bümming P, Meis-Kindblom JM et al (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer 103:821–829PubMedCrossRef

Miettinen M, Lasota J (2001) Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 438:1–12PubMedCrossRef

DeMatteo RP, Lewis JJ, Leung D et al (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58PubMedCrossRef

Pierie JP, Choudry U, Muzikansky A et al (2001) The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 136:383–389PubMedCrossRef

DeMatteo RP, Heinrich MC, El-Rifai WM et al (2002) Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 33:466–477PubMedCrossRef

Roberts PJ, Eisenberg B (2002) Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 38(suppl 5):S37–S38PubMedCrossRef

Connolly E, Gaffney E, Reynolds J (2003) Gastrointestinal stromal tumors. Br J Surg 90:1178–1186PubMedCrossRef

Wu P, Langerman B, Ryan C et al (2003) Surgical treatment of gastrointestinal stromal tumors in the imatinib (STI-571) era. Surgery 134:656–665PubMedCrossRef

10.

Bucher P, Egger JF, Gervaz P et al (2006) An audit of surgical management of gastrointestinal stromal tumors (GIST). Eur J Surg Oncol 32:310–314PubMedCrossRef

11.

Bümming P, Ahlman H, Andersson J et al (2006) Population-based study of the diagnosis and treatment of gastrointestinal stromal tumors. Br J Surg 93:836–843PubMedCrossRef

12.

Langer C, Gunawan B, Schuler P et al (2003) Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumors. Br J Surg 90:332–339PubMedCrossRef

13.

Aparicio T, Boige V, Sabourin J et al (2004) Prognostic factors after surgery of primary respectable gastrointestinal stromal tumors. Eur J Surg Oncol 30:1098–1103PubMedCrossRef

14.

Verreet PR, Clausing TA, Schoepp C (2000) Principles of surgical management of stromal tumor. Chirurg 71:1335–1344PubMedCrossRef

15.

Eisenberg B, Judson I (2004) Surgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol 11:465–475PubMedCrossRef

16.

Lehnert T (1998) Gastrointestinal sarcoma (GIST)—a review of surgical management. Ann Chir Gynaecol 87:297–305PubMed

17.

Hohenberger P, Reichardt P, Gebauer B et al (2004) Gastrointestinal stromal tumors (GIST)—current concepts of surgical management. Deutsch Med Wochenschr 129:1817–1820CrossRef

18.

Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New York

19.

Fletcher CDM, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465PubMedCrossRef

20.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef

21.

Miettinen M, Sobin LH, Lasota J (2005) 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 29:52–68PubMedCrossRef

22.

Tran T, Davila JA, El-Scrag HB (2005) The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1, 458 cases from 1992 to 2000. Am J Gastroenterol 100:162–168PubMedCrossRef

23.

Kindblom LG, Meis-Kindblom J, Bumming P et al (2003) Incidence, prevalence, phenotype and biologic spectrum of gastrointestinal stromal tumors (GIST): a population-based study of 600 cases (abstract). Ann Oncol 13(suppl 5):157

24.

Emory TS, Sobin LH, Lukes L et al (1999) Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 23:82–87PubMedCrossRef

25.

Miettinen M, Lasota J (2003) Gastrointestinal stromal tumors (GISTs): definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol 54:3–24PubMed

26.

Horton KM, Juluru K, Montogomery E et al (2004) Computed tomography imaging of gastrointestinal stromal tumors with pathology correlation. Comput Assist Tomogr 28:811–817CrossRef

27.

Hersh MR, Choi J, Garrett C et al (2005) Imaging gastrointestinal stromal tumors. Cancer Control 12:111–115PubMed

28.

Gouveia AM, Pimenta AP, Lopes JM et al (2005) Esophageal GIST: therapeutic implications of an uncommon presentation of a rare tumor. Dis Esophagus 18:70–73PubMedCrossRef

29.

DeMatteo RPRP, Maki RGRG, Antonescu CC et al (2003) Targeted molecular therapy for cancer: the application of STI571 to gastrointestinal stromal tumor. Curr Prob Surg 40:144–193CrossRef

30.

Gomes AL, Gouveia A, Capelinha AF et al (2008) Molecular alterations of KIT and PDGFRA in GISTs. An evaluation study of a Portuguese series. J Clin Pathol 61:203–208PubMedCrossRef

31.

Shiu MH, Farr GH, Papachristou DN et al (1982) Myosarcomas of the stomach: natural history, prognostic factors and management. Cancer 49:177–187PubMedCrossRef

32.

McGrath PC, Neifeld JP, Lawrence WJ et al (1987) Gastrointestinal sarcomas. Analysis of prognostic factors. Ann Surg 206:706–710PubMedCrossRef

33.

Ng EH, Pollock RE, Munsell MF et al (1992) Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging. Ann Surg 215:68–77PubMed

34.

Muro-Cacho CA, Cantor AB, Morgan M (2000) Prognostic factors in malignant gastrointestinal stromal tumors. Ann Clin Lab Sci 30:239–247PubMed

35.

Crosby JA, Catton CN, Davis A et al (2001) Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol 8:50–59PubMedCrossRef

36.

Miettinen M, El-Rifai W, H L Sobin L et al. (2002) Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 33:478–483

37.

Lin S, Huang M, Zeng C et al (2003) Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors. World Gastroenterol 9:2809–2812

38.

Fujimoto Y, Nakanishi Y, Yoshimura K et al (2003) 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 6:39–48PubMedCrossRef

39.

Wong NA, Young R, Malcomson RD et al (2003) Prognostic indicators for gastrointestinal stromal tumors: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach. Histopathology 43:118–126PubMedCrossRef

40.

Mochizuki Y, Kodera Y, Ito S et al (2004) Treatment and risk factors for recurrence after curative resection of gastrointestinal stromal tumors of the stomach. World J Surg 28:870–875PubMedCrossRef

41.

Wu TJ, Lee LY, Yeh CN et al (2006) Surgical treatment and prognostic analysis for gastrointestinal stromal tumors (GISTs) of the small intestine: before the era of imatinib mesylate. BMC Gastroenterol 6:29PubMedCrossRef

42.

Wardelmann E, Büttner R, Merkelbach-Bruse S et al (2007) Mutation analysis of gastrointestinal stromal tumors: increasing significance for risk assessment and effective targeted therapy. Virchows Arch 451:743–749PubMedCrossRef

43.

Corless CL, Fletcher JA, Heinrich MC (2004) Biology of gastrointestinal stromal tumors. J Clin Oncol 22:3813–3825PubMedCrossRef

44.

Bucher P, Villiger P, Egger JF et al (2004) Management of gastrointestinal stromal tumors: from diagnosis to treatment. Swiss Med Wkly 134:145–153PubMed

45.

Samiian L, Weaver M, Velanovich V (2004) Evaluation of gastrointestinal stromal tumors for recurrence rates and patterns of long-term follow-up. Am Surg 70:187–192PubMed

46.

Chou FF, Eng HL, Sheen-Chen SM (1996) Smooth muscle tumors of the gastrointestinal tract: analysis of prognostic factors. Surgery 119:171–177PubMedCrossRef

47.

Boni L, Benevento A, Dionigi G et al (2005) Surgical resection for gastrointestinal stromal tumors (GIST): experience on 25 patients. World J Surg Oncol 3:78PubMedCrossRef

48.

He LJ, Wang BS, Chen CC (1988) Smooth muscle tumors of the digestive tract: report of 160 cases. Br J Surg 75:184–186PubMedCrossRef

49.

Roy M, Sommers SC (1989) Metastatic potential of gastric leiomyosarcoma. Pathol Res Pract 185:874–877PubMed

50.

Franquemont DW, Frierson HF Jr (1992) Muscle differentiation and clinicopathologic features of gastrointestinal stromal tumors. Am J Surg Pathol 16:947–954PubMedCrossRef

51.

Pidhorecky I, Cheney RT, Kraybill WG et al (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7:705–712PubMedCrossRef

52.

Rossi CR, Mocellin S, Mencarelli R et al (2003) Gastrointestinal stromal tumors: from a surgical to a molecular approach. Int J Cancer 107:171–176PubMedCrossRef

53.

Dougherty MJ, Compton C, Talbert M et al (1990) Sarcoma of the gastrointestinal tract. Ann Surg 214:569–574CrossRef

54.

Lillemoe KD, Efron DT (2001) Gastrointestinal stromal tumors. In: Cameron JL, Gery L (eds) Current surgical therapy. St. Louis, Mosby, pp 112–117

55.

Joensuu H, Roberts PJ, Sarlomo-Rikala M et al (2001) Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344:1052–1056PubMedCrossRef

56.

van Oosterom AT, Judson I, Verweij J et al (2001) Safety and efficacy of imatinib (STI571) in metastatic gastrointestinal stromal tumors: a phase I study. Lancet 358:1421–1423PubMedCrossRef

57.

Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472–480PubMedCrossRef

58.

Verweij J, Casali PG, Zalcberg J et al (2004) Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 364:1127–1134PubMedCrossRef

59.

DeMatteo RP (2002) The GIST of targeted cancer therapy: a tumor (gastrointestinal stromal tumor), a mutated gene (c-kit), and a molecular inhibitor (STI571). Ann Surg Oncol 9:831–839PubMedCrossRef

60.

Bümming P, Andersson J, Meis-Kindblom JM et al (2003) Neoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients. Br J Cancer 89:460–464PubMedCrossRef

61.

Nilsson B, Sjölund K, Kindblom LG et al (2007) Adjuvant imatinib treatment improves recurrence-free survival in patients with high-risk gastrointestinal stromal tumours (GIST). Br J Cancer 96:1656–1658PubMedCrossRef

62.

Trupiano J, Stewart R, Misick C et al (2002) Gastric stromal tumors, a clinicopathological study of 77 cases with correlation of features with nonaggressive and aggressive clinical behaviour. Am J Surg Pathol 26:705–714PubMedCrossRef

63.

Sanders L, Silverman M, Rossi R et al (1996) Gastric smooth muscle tumors: diagnostic dilemmas and factors affecting outcome. World J Surg 20:992–995PubMedCrossRef

64.

Ludwig DJ, Traverso LW (1997) Gut stromal tumors and their clinical behavior. Am J Surg 173:390–394PubMedCrossRef

65.

Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30:1213–1220PubMedCrossRef

66.

Bucher P, Taylor S, Villiger P et al (2004) For small intestinal stromal tumors are there prognostic factors. Am J Surg 187:761–766PubMedCrossRef

67.

Mudan SS, Conlon KC, Woodruff JM et al (2000) Salvage surgery for patients with recurrent gastrointestinal sarcoma: prognostic factors to guide patient selection. Cancer 88:66–74PubMedCrossRef

68.

Pross M, Manger T, Schulz HU et al (1999) Gastrointestinal stromal tumors—problems in diagnosis and therapy. Chirurg 70:807–812PubMedCrossRef

69.

Heinrich MC, Corless CL (2005) Gastric GI stromal tumors (GISTs): the role of surgery in the era of targeted therapy. J Surg Oncol 90:195–207PubMedCrossRef

70.

Demetri GD, Baker LH, Benjamin RS et al (2007) Soft tissue sarcoma. J Natl Compr Cancer Netw 5:364–399

71.

Yan H, Marchettini P, Acherman YI et al (2003) Prognostic assessment of gastrointestinal stromal tumor. Am J Clin Oncol 26:221–228PubMedCrossRef

Title: Surgical Margin Status and Prognosis of Gastrointestinal Stromal Tumor
Authors: António M. Gouveia
Amadeu P. Pimenta
Ana F. Capelinha
Dionísio de la Cruz
Paula Silva
José M. Lopes
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-008-9704-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical Margin Status and Prognosis of Gastrointestinal Stromal Tumor

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2008

HA/GSA-Rmax Ratio as a Predictor of Postoperative Liver Failure

Benefits of Liver Transplantation Surgical Techniques in the Management of Extensive Retroperitoneal Tumors

Conflict Resolution: Practical Principles for Surgeons

Prognosis of Japanese Breast Cancer Based on Hormone Receptor and HER2 Expression Determined by Immunohistochemical Staining

Surgical Factors Influencing Outcomes in Patients Resected for Cancer of the Esophagus or Gastric Cardia

Incidence of Parathyroid Glands Located in Thymus in Patients with Renal Hyperparathyroidism