Epidemiology, prognostication and treatment outcome of gastrointestinal stromal tumour: A single centre prospective study

Abstract

Introduction and Aim: GI stromal tumours (GISTs) being most frequent mesenchymal tumours of the alimentary tract have few studies on epidemiology in this subcontinent. The current prospective study is aimed at gathering data on the molecular epidemiology and possible effect of molecular markers on standard pathological prognostic factors and also to measure the overall disease outcome.
 
 Materials and Methods: In this prospective epidemiologic study conducted from 2016 to 2019, all GIST patients registering at the Radiotherapy Department of IPGME & R, Kolkata, India; identified by histopathology were prescribed pre-specified immune-histochemical tests and offered a protocolized treatment. The patients were followed up for a minimum of twelve months and on average for thirty months, to watch for disease progression.
 
 Results: A total of 38 patients with median age 49.5 years with male predominance (p= 0.005) presented most commonly with abdominal pain (42.1%); jejunum (31.6%) followed by stomach (26.3%) being most common sites, spindle cell type (78.9%) being commonest histological type. Immunohistochemistry showed positive expression for SMA (7.9%), DOG1 (28.9%), CD34 (31.6%), CD117/cKIT (65.8%). CD117 positivity (Rho= -0.366, p=0.024) has negative association with mitotic count, whereas DOG1 (Rho=.513, p=0.001) and CD34 (Rho=.459, p=0.004) positivity have positive association with tumour dimension. DOG1 positivity was found to be a contributing factor of disease progression (RR 12.57, p=0.035).
 
 Conclusion: In sub-continental patients, gender and age distribution of GISTs differ from western countries but not pathological features. Molecular markers have important prognostic significance.