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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2018

Open Access 01-07-2018 | Bone and Soft Tissue Sarcomas

Clinicopathological Features and Prognosis of Primary GISTs with Tumor Rupture in the Real World

Authors: Toshirou Nishida, Haruhiko Cho, Seiichi Hirota, Toru Masuzawa, Gaku Chiguchi, Toshimasa Tsujinaka, the Kinki GIST Study Group

Published in: Annals of Surgical Oncology | Issue 7/2018

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Abstract

Background

Patients with ruptured gastrointestinal stromal tumor (GIST) are recommended for imatinib adjuvant therapy; however, their clinicopathological features and prognosis in the era of imatinib are unknown.

Patients and Methods

The study cohort included 665 patients with histologically proven primary GISTs who underwent R0 or R1 surgery between 2003 and 2007; the validation cohort included 182 patients between 2000 and 2014. The definitions of tumor rupture in the study included perforation at tumor site, tumor fracture, piecemeal resection including open biopsy, and macroscopic injuries to the pseudocapsule.

Results

Tumor rupture occurred in 21 (3.2%) of 665 and 5 (2.9%) of 182 patients in the study and validation cohort, respectively. Ruptured GISTs were more symptomatic, were larger in size, and had higher mitotic count than nonruptured GISTs but were not associated with tumor location or laparoscopic surgery. GISTs with intraoperative rupture had clinicopathological features and prognostic outcomes similar to those with preoperative rupture. Recurrence rates were higher and median recurrence-free survival (RFS) and overall survival (OS) were shorter with ruptured than nonruptured GIST. Tumor rupture was one of the independent prognostic factors for RFS, but not OS, according to multivariate analysis.

Conclusions

Ruptured GISTs were symptomatic larger tumors with high mitotic activity, frequent relapse, and shorter RFS. Tumor rupture was an independent prognostic factor for RFS, but not for OS, in the era of imatinib.
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Metadata
Title
Clinicopathological Features and Prognosis of Primary GISTs with Tumor Rupture in the Real World
Authors
Toshirou Nishida
Haruhiko Cho
Seiichi Hirota
Toru Masuzawa
Gaku Chiguchi
Toshimasa Tsujinaka
the Kinki GIST Study Group
Publication date
01-07-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6505-7

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