Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2013 | Research

Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors

Authors: Jianjun Yang, Fan Feng, Mengbin Li, Li Sun, Liu Hong, Lei Cai, Wenbin Wang, Guanghui Xu, Hongwei Zhang

Published in: World Journal of Surgical Oncology | Issue 1/2013

Abstract

Background

The National Comprehensive Cancer Network (NCCN) recommends conservative follow-up for gastric gastrointestinal stromal tumors (GISTs) less than 2 cm. The aim of the present study was to investigate the clinical and pathological features of small gastric GISTs, re-evaluate the risk potential, and discuss the treatment strategy of small gastric GISTs.

Methods

In this retrospective study, 63 cases of small gastric GISTs (less than 2 cm) were resected surgically from May 2010 to March 2013 in our department. Clinicopathological factors were collected and the malignant potential of small gastric GISTs was analyzed.

Results

The mitotic index of 14 out of 63 cases (22.22%) exceeded 5. The malignant potential of small gastric GISTs was related to tumor location (P = 0.0218). The mitotic index of 4 out of 8 GISTs (50%) located in gastric cardia exceeded 5, 8 out 28 GISTs (28.57%) located in the gastric fundus exceeded 5, and only 2 out of 27 GISTs (7.41%) located in the gastric body exceeded 5. We also discovered a good consistency between mitotic index and Ki-67 expression of small gastric GISTs.

Conclusions

Gastric GISTs less than 2 cm also have malignant potential. Thus, we recommended surgical resection of all small gastric GISTs once diagnosed.

Grignol VP, Termuhlen PM: Gastrointestinal stromal tumor surgery and adjuvant therapy. Surg Clin North Am. 2011, 91: 1079-1087. 10.1016/j.suc.2011.06.007.CrossRefPubMed

Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, Muhammad Tunio G, Matsuzawa Y, Kanakura Y, Shinomura Y, Kitamura Y: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998, 279: 577-580. 10.1126/science.279.5350.577.CrossRefPubMed

Miettinen M, Lasota J: Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006, 130: 1466-1478.PubMed

Agaimy A, Wang LM, Eck M, Haller F, Chetty R: Loss of DOG-1 expression associated with shift from spindled to epithelioid morphology in gastric gastrointestinal stromal tumors with KIT and platelet-derived growth factor receptor α mutations. Ann Diagn Pathol. 2013, 17: 187-191. 10.1016/j.anndiagpath.2012.10.005.CrossRefPubMed

De Vogelaere K, Van Loo I, Peters O, Hoorens A, Haentjens P, Delvaux G: Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc. 2012, 26: 2339-2345. 10.1007/s00464-012-2186-7.CrossRefPubMed

Casella C, Villanacci V, D'Adda F, Codazzi M, Salerni B: Primary extra-gastrointestinal stromal tumor of retroperitoneum. Clin Med Insights Oncol. 2012, 6: 189-197.PubMedCentralCrossRefPubMed

Maor Y, Avidan B, Melzer E, Bar-Meir S: Long-term clinical outcome of patients with gastric gastrointestinal stromal tumors. Dig Dis Sci. 2010, 55: 2893-2898. 10.1007/s10620-009-1107-7.CrossRefPubMed

von Mehren M, Benjamin RS, Bui MM, Casper ES, Conrad EU, DeLaney TF, Ganjoo KN, George S, Gonzalez R, Heslin MJ, Kane JM, Mayerson J, McGarry SV, Meyer C, O'Donnell RJ, Paz B, Pfeifer JD, Pollock RE, Randall RL, Riedel RF, Schuetze S, Schupak KD, Schwartz HS, Shankar S, Van Tine BA, Wayne J, Sundar H, McMillian NR: Soft tissue sarcoma, version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012, 10: 951-960.PubMed

Lai IR, Chen CN, Lin MT, Lee PH: Surgical treatment of gastric gastrointestinal stromal tumors: analysis of 92 operated patients. Dig Surg. 2008, 25: 208-212. 10.1159/000140691.CrossRefPubMed

10.

Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, Corless CL, Debiec-Rychter M, DeMatteo RP, Ettinger DS, Fisher GA, Fletcher CD, Gronchi A, Hohenberger P, Hughes M, Joensuu H, Judson I, Le Cesne A, Maki RG, Morse M, Pappo AS, Pisters PW, Raut CP, Reichardt P, Tyler DS, van den Abbeele AD, von Mehren M, Wayne JD, Zalcberg J, NCCN Task Force: NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007, 5 (Suppl 2): S1-S29. quiz S30PubMed

11.

Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY, ESMO Guidelines Working Group: Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009, 20 (Suppl 4): 64-67.PubMed

12.

Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD: Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol. 2012, 35: 451-454. 10.1097/COC.0b013e31821954a7.CrossRefPubMed

13.

Kim MY, Park YS, Choi KD, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Jung HY, Kim JH, Yun SC, Kim KC, Yook JH, Oh ST, Kim BS, Ryu MH, Kang YK: Predictors of recurrence after resection of small gastric gastrointestinal stromal tumors of 5 cm or less. J Clin Gastroenterol. 2012, 46: 130-10.1097/MCG.0b013e31821f8bf6.CrossRefPubMed

14.

Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD: NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010, 8 (Suppl 2): S1-S41. quiz S42-44PubMedCentralPubMed

15.

Corless CL, McGreevey L, Haley A, Town A, Heinrich MC: KIT mutations are common in incidental gastrointestinal stromal tumors one centimeter or less in size. Am J Pathol. 2002, 160: 1567-1572. 10.1016/S0002-9440(10)61103-0.PubMedCentralCrossRefPubMed

16.

Sui XL, Wang H, Sun XW: Expression of DOG1, CD117 and PDGFRA in gastrointestinal stromal tumors and correlations with clinicopathology. Asian Pac J Cancer Prev. 2012, 13: 1389-1393. 10.7314/APJCP.2012.13.4.1389.CrossRefPubMed

17.

West RB, Corless CL, Chen X, Rubin BP, Subramanian S, Montgomery K, Zhu S, Ball CA, Nielsen TO, Patel R, Goldblum JR, Brown PO, Heinrich MC, van de Rijn M: The novel marker, DOG1, is expressed ubiquitously in gastrointestinal stromal tumors irrespective of KIT or PDGFRA mutation status. Am J Pathol. 2004, 165: 107-113. 10.1016/S0002-9440(10)63279-8.PubMedCentralCrossRefPubMed

18.

Lai EC, Lau SH, Lau WY: Current management of gastrointestinal stromal tumors–a comprehensive review. Int J Surg. 2012, 10: 334-340. 10.1016/j.ijsu.2012.05.007.CrossRefPubMed

19.

Dematteo RP, Gold JS, Saran L, Gönen M, Liau KH, Maki RG, Singer S, Besmer P, Brennan MF, Antonescu CR: Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer. 2008, 112: 608-615. 10.1002/cncr.23199.CrossRefPubMed

20.

Roggin KK, Posner MC: Modern treatment of gastric gastrointestinal stromal tumors. World J Gastroenterol. 2012, 18: 6720-6728. 10.3748/wjg.v18.i46.6720.PubMedCentralCrossRefPubMed

21.

Fujimoto A, Kobayashi T, Uchida S, Ichinose Y, Sasaoki T, Goto K, Okabe H: Laparoscopic total gastrectomy for multiple sporadic gastric gastrointestinal stromal tumors: report of a case. Surg Today. 2012, 42: 84-88. 10.1007/s00595-011-0011-x.CrossRefPubMed

22.

Corless CL, Barnett CM, Heinrich MC: Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer. 2011, 11: 865-878.PubMed

23.

Miettinen M, Lasota J: Histopathology of gastrointestinal stromal tumor. J Surg Oncol. 2011, 104: 865-873. 10.1002/jso.21945.CrossRefPubMed

24.

Lasota J, Miettinen M: Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours. Histopathology. 2008, 53: 245-266. 10.1111/j.1365-2559.2008.02977.x.CrossRefPubMed

25.

Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, Singer S, Griffith DJ, Haley A, Town A, Demetri GD, Fletcher CD, Fletcher JA: PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003, 299: 708-710. 10.1126/science.1079666.CrossRefPubMed

26.

Hostein I, Faur N, Primois C, Boury F, Denard J, Emile JF, Bringuier PP, Scoazec JY, Coindre JM: BRAF mutation status in gastrointestinal stromal tumors. Am J Clin Pathol. 2010, 133: 141-148. 10.1309/AJCPPCKGA2QGBJ1R.CrossRefPubMed

27.

Liegl-Atzwanger B, Fletcher JA, Fletcher CD: Gastrointestinal stromal tumors. Virchows Arch. 2010, 456: 111-127. 10.1007/s00428-010-0891-y.CrossRefPubMed

28.

Patil DT, Rubin BP: Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med. 2011, 135: 1298-1310. 10.5858/arpa.2011-0022-RA.CrossRefPubMed

Title: Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors
Authors: Jianjun Yang
Fan Feng
Mengbin Li
Li Sun
Liu Hong
Lei Cai
Wenbin Wang
Guanghui Xu
Hongwei Zhang
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2013
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-11-273

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Contemporary adjuvant polymethyl methacrylate cementation optimally limits recurrence in primary giant cell tumor of bone patients compared to bone grafting: a systematic review and meta-analysis

Silencing of mutant p53 by siRNA induces cell cycle arrest and apoptosis in human bladder cancer cells

Clinicopathological features and CCT2 and PDIA2 expression in gallbladder squamous/adenosquamous carcinoma and gallbladder adenocarcinoma

Clinical implication of the BRAFV600E mutation in papillary thyroid carcinoma

Multiple bilateral oncocytomas of the native kidneys following renal transplantation: report of a rare case and review of the literature

Clinical and pathological features of hepatoid carcinoma of the ovary