Abstract
BackgroundGastrointestinal stromal tumors (GIST) are infrequent and diagnosis and prognosis could be troublesome. We present short and long term results of surgical resection for GIST at the Department of Surgery, University of Insubria, during a period of 17 years.Materials and methodsAll patients' data, tumor characteristics, surgical procedure and survival data were analyzed retrospectively. Tumors were divided in risk classes using the classification proposed by Fletcher, based on tumor size and number of mitosis.ResultsBetween 1987 and 2004, 25 patients underwent surgical resection for GIST. Stomach was the most common site of localization. Complete resection was achieved in 88% cases, while in 12% radical resection was not possible. The mean tumor size was 9.2 cm (1.2 – 30 cm): <5 cm diameter in 14/25 cases (56%), 5–10 cm in 5/25 (20%) and >10 cm in 6/25 (24%). Mitotic count was <10/50 HPF in 68% (17/25) and >10/50 in 32% (8/25). Using Fletcher's classification, tumors were divided in very low (11/25, 44%), low (4/25, 16%), intermediate (6/25, 24%) and high-risk (4/25, 16%) groups. The 5-year overall survival was 65% and 34% respectively with a statistically significant difference between tumors <5 cm and >10 cm in diameter and between complete and incomplete resection. High-risk tumors had a significantly shorter survival than low or very low risk.ConclusionOur experience confirms that GIST's are uncommon and aggressive cancers. The prognosis is strictly related to tumor size and number of mitosis. Although significant advances on new chemotherapeutic regimes have been made, to date, only radical surgery offers the chance of long-term survival.
Highlights
Gastrointestinal stromal tumors (GIST) are infrequent and diagnosis and prognosis could be troublesome
The prognosis is strictly related to tumor size and number of mitosis
Histopathological examination of surgical specimens was carried out using standard hematoxylin and eosin staining as well as specific immunohistochemical techniques allowing the identification of tumor's grade, size, cellular pattern, stromal background, stage and number of mitosis at high-power field (HPF)
Summary
Gastrointestinal stromal tumors (GIST) are infrequent and diagnosis and prognosis could be troublesome. Gastrointestinal stromal tumors (GIST) are extremely unusual neoplasm accounting for less than 1% of all gastrointestinal tumors, arising from the Cajal's interstitial cells located in mesodermal tissue They are defined as primary mesenchymal tumors, typically staining positive for the expression of c-KIT protein [1]. Histopathological examination of surgical specimens was carried out using standard hematoxylin and eosin staining as well as specific immunohistochemical techniques allowing the identification of tumor's grade (low, moderate, and high), size, cellular pattern, stromal background, stage and number of mitosis at high-power field (HPF). Overall survival after surgical resection and clinical behavior of GIST are depending to tumor size and mitotic count, regardless their benign or malignant microscopic features [3]. Fletcher et al [2] divided GIST in different classes of risk, based on the analysis of prognostic factors [4,5] classifying these tumors in different "risk classes"
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