Yıl: 2020 Cilt: 36 Sayı: 2 Sayfa Aralığı: 209 - 217 Metin Dili: İngilizce DOI: 10.5578/turkjsurg.4389 İndeks Tarihi: 16-12-2020

Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors

Öz:
Objective: The aim of this study was to evaluate the prognostic factors effecting recurrence risk and disease-free survival of the patients who were diagnosed as gastrointestinal stromal tumor after complete resection of the tumor with or without adjuvant therapy.Material and Methods: Between the years 2005 and 2013, data of 71 patients including clinical and demographic features, tumor localizations, patho-logic examinations, survival and recurrence rates were enrolled into this retrospective study.Results: Male/female ratio was 1.71, and mean age was 60.27 ± 14.65 years. Forty-two (59.2%) patients had tumor in stomach, 16 (22.5%) in small bowel, whereas 12 (16.9%) had extra-gastrointestinal system and one patient (%1.4) had rectal localization. Modified NIH risk stratification scheme categorized 9 (12.68%) patients in very low-, 12 (16.90%) in low-, 21 (29.58%) patients in moderate-and 29 (40.85%) patients in high-risk group. Twenty-four (33.8%) patients had a metastatic disease at follow-up while 13 (18.3%) patients were metastatic at admission. R0 resection was successfully performed in 51 (71.8%) patients, while R1 resection in 9 (12.7%) and R2 resection in 11 (15.5%) were achieved. Mean follow-up time was 47.12 ± 33.52 months (range, 1-171 months). Nineteen (26.8%) patients demonstrated recurrence with a mean time of 22.16 ± 15.89 months (range, 3-57 months). During follow-up 17 (23.9%) patients were deceased. In univariate analysis, high-risk group, small bowel and extra-gastrointestinal system localization, R1-2 resection, necrosis, positive resection margin and invasion of surrounding tissues, metastatic disease and adjuvant therapy were statistically significant in terms of recurrence. Multivariate analysis presented small bowel and extra-gastrointestinal system localization, R2 resection, mitoses count, invasion and adjuvant therapy as independent prognostic risk factors affecting disease-free survival rates. The 1, 3 and 5 years of disease-free survival rates of the patients were 89.6%, 75.4%, 64.3%, respectively.Conclusion: As mentioned in the literature, the mainstay of curative therapy of gastrointestinal stromal tumor is surgery. In our study, not only small bowel, extra-gastrointestinal system localization and invasion of surrounding tissues by tumor, but also R2 resection that complicate the local control of the disease were represented as independent adverse prognostic factors for disease-free survival. Unfavourable clinical outcomes of adjuvant therapy over the disease-free survival was linked to higher tumor stage with metastatic disease and emphasized that prospective trials with more cases should be practiced.
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Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Grignol VP, Termuhlen PM. Gastrointestinal stromal tumor surgery and adjuvant therapy. Surg Clin North Am 2011; 91 (5): 1079-87. [CrossRef ]
  • 2. Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gast-rointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005; 100 (1): 162-8. [CrossRef ]
  • 3. Graadt van Roggen JF, van Velthuysen ML, Hogendoorn PC. The histo-pathological differential diagnosis of gastrointestinal stromal tumo-urs. J Clin Pathol 2001; 54 (2): 96-102. [CrossRef ]
  • 4. Gold JS, Dematteo RP. Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg 2006; 244 (2): 176-84. [CrossRef ]
  • 5. Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavs-son B, et al. Gastrointestinal stromal tumors: the incidence, prevalen-ce, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 2005; 103 (4): 821-9. [CrossRef ]
  • 6. Joensuu H, Vehtari A, Riihimaki J, Nishida T, Steigen SE, Brabec P, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 2012; 13 (3): 265-74. [CrossRef ]
  • 7. Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001; 438 (1): 1-12. [CrossRef ]
  • 8. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diag-nosis. Arch Pathol Lab Med 2006; 130 (10): 1466-78. [CrossRef ]
  • 9. Koay MH, Goh YW, Iacopetta B, Grieu F, Segal A, Sterrett GF, et al. Gast-rointestinal stromal tumours (GISTs): a clinicopathological and mole-cular study of 66 cases. Pathol 2005; 37 (1): 22-31. [CrossRef ]
  • 10. Miettinen M, Lasota J. Gastrointestinal stromal tumors. Gastroenterol Clin North Am 2013; 42 (2): 399-415. [CrossRef ]
  • 11. Hatipoglu E, Demiryas S. Gastrointestinal stromal tumors: 16 years’ experience within a university hospital. Rev Esp Enferm Dig 2018; 110 (6): 358-64. [CrossRef ]
  • 12. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002; 33 (5): 459-65. [CrossRef ]
  • 13. Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ. Prognosis of gastroin-testinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 1999; 23 (1): 82-7. [CrossRef ]
  • 14. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence pat-terns and prognostic factors for survival. Ann Surg 2000; 231 (1): 51-8. [CrossRef ]
  • 15. Dematteo RP, Gold JS, Saran L, Gonen M, Liau KH, Maki RG, et al. Tu-mor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST ). Can-cer 2008; 112 (3): 608-15. [CrossRef ]
  • 16. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006; 23 (2): 70-83. [CrossRef ]
  • 17. Miettinen M, Furlong M, Sarlomo-Rikala M, Burke A, Sobin LH, Lasota J. Gastrointestinal stromal tumors, intramural leiomyomas, and lei-omyosarcomas in the rectum and anus: a clinicopathologic, immu-nohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 2001; 25 (9): 1121-33. [CrossRef ]
  • 18. Miettinen M, El-Rifai W, Sobin LHL, Lasota J. Evaluation of malig-nancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 2002; 33 (5): 478-83. [CrossRef ]
  • 19. Catena F, Di Battista M, Ansaloni L, Pantaleo M, Fusaroli P, Di Scios-cio V, et al. Microscopic margins of resection influence primary gast-rointestinal stromal tumor survival. Onkologie 2012; 35 (11): 645-8. [CrossRef
  • 20. McCarter MD, Antonescu CR, Ballman KV, Maki RG, Pisters PW, Demet-ri GD, et al. Microscopically positive margins for primary gastrointes-tinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg 2012; 215 (1): 53-9. [CrossRef ]
  • 21. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and mole-cular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol 2005; 29 (1): 52-68. [CrossRef ]
  • 22. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumo-urs. Br J Surg 2003; 90 (10): 1178-86. [CrossRef ]
  • 23. Sturgeon C, Chejfec G, Espat NJ. Gastrointestinal stromal tumors: a spectrum of disease. Surg Oncol 2003; 12 (1): 21-6. [CrossRef ]
  • 24. Dei Tos AP. The reappraisal of gastrointestinal stromal tumors: from Sto-ut to the KIT revolution. Virchows Arch 2003; 442 (5): 421-8. [CrossRef ]
  • 25. Joensuu H. Risk stratification of patients diagnosed with gastrointes-tinal stromal tumor. Hum Pathol 2008; 39 (10): 1411-9. [CrossRef ]
  • 26. Goldblum JR, Appelman HD. Stromal tumors of the duodenum. A histologic and immunohistochemical study of 20 cases. Am J Surg Pathol 1995; 19 (1): 71-80. [CrossRef ]
  • 27. Learn PA, Sicklick JK, DeMatteo RP. Randomized clinical trials in gast-rointestinal stromal tumors. Surg Oncol Clin North Am 2010; 19 (1): 101-13. [CrossRef ]
  • 28. Scaife CL, Hunt KK, Patel SR, Benjamin RS, Burgess MA, Chen LL, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastro-intestinal stromal tumors treated with imatinib mesylate? Am J Surg 2003; 186 (6): 665-9. [CrossRef ]
  • 29. Molinas Mandel N, Selcukbiricik F, Kanitez M, Yalcin S, Tural D, Erda-mar S, et al. Clinical and pathological characteristics and their effect on survival in elderly patients with gastrointestinal stromal tumors. JBUON 2016; 21 (2): 360-5. [CrossRef ]
APA Senol K, Dağlar Özdemir G, AKAT A, Kama N (2020). Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. , 209 - 217. 10.5578/turkjsurg.4389
Chicago Senol Kazim,Dağlar Özdemir Gül,AKAT ARIF ZEKI,Kama Nuri Aydın Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. (2020): 209 - 217. 10.5578/turkjsurg.4389
MLA Senol Kazim,Dağlar Özdemir Gül,AKAT ARIF ZEKI,Kama Nuri Aydın Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. , 2020, ss.209 - 217. 10.5578/turkjsurg.4389
AMA Senol K,Dağlar Özdemir G,AKAT A,Kama N Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. . 2020; 209 - 217. 10.5578/turkjsurg.4389
Vancouver Senol K,Dağlar Özdemir G,AKAT A,Kama N Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. . 2020; 209 - 217. 10.5578/turkjsurg.4389
IEEE Senol K,Dağlar Özdemir G,AKAT A,Kama N "Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors." , ss.209 - 217, 2020. 10.5578/turkjsurg.4389
ISNAD Senol, Kazim vd. "Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors". (2020), 209-217. https://doi.org/10.5578/turkjsurg.4389
APA Senol K, Dağlar Özdemir G, AKAT A, Kama N (2020). Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turkish Journal of Surgery, 36(2), 209 - 217. 10.5578/turkjsurg.4389
Chicago Senol Kazim,Dağlar Özdemir Gül,AKAT ARIF ZEKI,Kama Nuri Aydın Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turkish Journal of Surgery 36, no.2 (2020): 209 - 217. 10.5578/turkjsurg.4389
MLA Senol Kazim,Dağlar Özdemir Gül,AKAT ARIF ZEKI,Kama Nuri Aydın Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turkish Journal of Surgery, vol.36, no.2, 2020, ss.209 - 217. 10.5578/turkjsurg.4389
AMA Senol K,Dağlar Özdemir G,AKAT A,Kama N Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turkish Journal of Surgery. 2020; 36(2): 209 - 217. 10.5578/turkjsurg.4389
Vancouver Senol K,Dağlar Özdemir G,AKAT A,Kama N Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turkish Journal of Surgery. 2020; 36(2): 209 - 217. 10.5578/turkjsurg.4389
IEEE Senol K,Dağlar Özdemir G,AKAT A,Kama N "Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors." Turkish Journal of Surgery, 36, ss.209 - 217, 2020. 10.5578/turkjsurg.4389
ISNAD Senol, Kazim vd. "Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors". Turkish Journal of Surgery 36/2 (2020), 209-217. https://doi.org/10.5578/turkjsurg.4389