ASO Author Reflections: The Significance of Tumor Rupture in Gastric Gastrointestinal Stromal Tumors

Excerpt

In 2008, tumor rupture was included as a high-risk feature in the modified National Institutes of Health criteria for localized gastrointestinal stromal tumor (GIST).1 Based on an analysis of pooled population-based series, rupture has been established as an independent risk factor.2 However, in that retrospective study, tumor rupture was not predefined, the incidence ranged from 4 to 22% across the series, and certain criteria, e.g. R1 resection and mucosal defects, were inconsistently coded as rupture. A strict definition of tumor rupture has been proposed by the Oslo Sarcoma Group, distinguishing six criteria—termed rupture—from four clinical settings with minor defects of tumor integrity not considered rupture.3 In an analysis of small intestinal GISTs, rupture according to this definition was independently associated with recurrence on multivariable analysis. Adjuvant imatinib, possibly for life, is currently recommended after rupture, and a clear-cut definition is needed. In the present study, the Oslo definition was applied on a larger cohort of gastric GIST patients. …