Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels.

Tianzhu Liu,Yongsong Ye,Lesheng Huang,Wanchun Zhang,Jinghua Jiang,Jiahui Tang,Kaili Cai,Jun Chen,Lei Guo,Hongyi Li,Xiaohua Du,Gao Lin,Xiaosong Jiang,Hui Peng,Ulrich Wellner

doi:10.1371/journal.pone.0261566

Abstract

An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.

Highlights

We retrospectively reviewed the medical records of patients with primary gastrointestinal stromal tumor (GIST) admitted to the Guangdong Hospital of Traditional Chinese Medicine (Zhuhai, 519000, China) and Zhuhai Hospital affiliated to Guangdong Hospital of Traditional Chinese Medicine (Zhuhai, Guangdong, China) over five years between January 2015 and December 2020
Depending on whether or not air-fluid levels or air bubbles were observed on magnetic resonance imaging (MRI) or computed tomography (CT) images, the patients were divided into two groups: those with air-fluid levels or air bubbles as the experimental group (n = 17) and those without air-fluid levels or air bubbles as the control group (n = 58)
Based on the imaging and histopathological findings of this study, we found that the ratios of the irregular shape of the tumor, invasion of adjacent organs, and National Institutes of Health (NIH) higher risk categories were significantly higher in GISTs with airfluid levels compared with GISTs without air-fluid levels

Summary

Introduction

GIST can occur throughout the entire GI tract, with the stomach and the small intestine as the two most common sites, accounting for 60% and 30%, respectively [2]. Most patients (69%) with primary GIST arising in the GI tract present with clinical symptoms. A small proportion of GISTs are asymptomatic, and the tumor without symptoms is usually incidentally detected during imaging, by palpation, at surgery for other conditions, or at autopsy [4]. The main therapeutic approaches for patients with GISTs are surgery and targeted drug therapy, while other less common treatments include chemotherapy, ablation and embolization, and radiation therapy [2]

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