Gastric Gastric Gastrointestinal Stromal Tumors Patients Research Articles

Safety and efficacy of endoscopic resection for gastric gastrointestinal stromal tumors: a retrospective cohort study

Background The aim of this study was to verify the safety and efficacy of endoscopic resection (ER) for gastric gastrointestinal stromal tumors (GISTs). Methods Among a consecutive series of resections for gastric GISTs performed in a single center, the outcomes of patients who had ER were compared to standard surgical resection (SR). Results In the cohort, 329 consecutive primary localized gastric GISTs patients (n, ER/SR = 251/78) were enrolled. Patients receiving ER were revealed to have preferable post-treatment outcomes, prolonged overall survival (OS) and disease-free survival (DFS). Tumor diameter, the only independent risk factor for a complicated post-operative course, was utilized for propensity score matching (PSM). In the PSM cohort, patients receiving ER and SR with similar tumor size (4.0 [2.7–4.5] cm) shared similar aggressiveness in terms of stomach layers of tumor origination and invasion, and modified National Institutes of Health (mNIH) risk criteria. Shorter operative time, fewer economic costs, and shorter post-operative stay were still observed in the ER group (ER vs. SR: 80 [49–120] vs. 120 [98–160] minutes, p < 0.001; 44 [38–51] vs. 60 [49–84] thousand Renminbi [kRMB], p < 0.001; 7.0 [6.0–8.0] vs. 8.5 [6.0–12] days, p = 0.018, respectively). No significant difference in OS and DFS was demonstrated in the PSM cohort. Conclusions ER is safe and effective, thus a feasible treatment option for indicated gastric GISTs patients with the advantage of faster recovery and lower economic costs.

Association between calcification and risk stratification in gastric gastrointestinal stromal tumors.

Risk assessment of gastric gastrointestinal stromal tumors (GISTs), particularly those with a diameter ≤ 5cm, remains a clinical challenge. Previous research has primarily focused on tumor size, ulceration, necrosis, and enhancement patterns, with less emphasis on the role of tumor calcification, which remains controversial regarding its correlation with malignancy risk. This study aims to explore the characteristics of calcification in gastric GISTs and its correlation with risk stratification as defined by the National Institutes of Health (NIH), to improve preoperative risk assessment for gastric GISTs ≤ 5cm. A retrospective analysis of 385 pathologically confirmed gastric GIST patients, including 178 with small gastric GISTs (< 2cm), was conducted. Tumors were categorized into low-risk (very low / low) and high-risk (intermediate / high) groups based on NIH criteria. Variables such as age, gender, tumor long-axis diameter, calcification rates, calcification size, the number and distribution of calcification, calcification to tumor long-axis diameter ratio were analyzed. Logistic regression was used to identify independent predictors of malignancy for gastric GISTs, with predictive values assessed via receiver operating characteristic (ROC) curves. Significant differences were found between high-risk and low-risk groups in treatment methods, tumor long-axis diameter, the ratio of calcification to tumor long-axis, and calcification distribution (P < 0.05). Calcification rates varied across risk categories, with 23.6% in very low-risk, 31.6% in low-risk, 9.8% in intermediate-risk, and 31.7% in high-risk categories (P < 0.05). In GISTs ≤ 5cm, both tumor long-axis diameter (OR = 3.07, 95% CI: 2.29-4.10) and calcification (OR = 0.36, 95% CI: 0.13-0.97) were independent predictors of malignancy risk (both P < 0.05). ROC curve analysis yielded areas of 0.849 for tumor long-axis diameter, 0.578 for calcification, and 0.862 for their combination. The study indicates lower calcification rates in intermediate-risk gastric GISTs and higher rates in other risk categories. Additionally, tumors of different sizes exhibit two distinct calcification patterns, suggesting possible differing mechanisms of calcification in tumors. Calcification in gastric GISTs ≤ 5cm acts as a protective factor against higher malignancy risk, and when combined with tumor long-axis diameter, significantly enhances predictive accuracy over long-axis diameter alone.

Correlation analysis of multi-slice computed tomography (MSCT) findings, clinicopathological factors, and prognosis of gastric gastrointestinal stromal tumors.

BackgroundComputed tomography (CT) findings and clinicopathological characteristics of gastric gastrointestinal stromal tumors (GISTs) have been reported in the past, however, studies on their association with prognosis are limited. We aimed to evaluate the correlation between multi-slice computed tomography (MSCT) findings and clinicopathological characteristics for the prognosis of gastric GISTs. Multiple independent factors influencing the prognostic assessment of gastric GISTs were recognized.MethodsThe CT images and clinicopathological data of 155 patients with gastric GISTs were retrospectively analyzed. Progression-free survival of patients was obtained using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic significance of CT imaging and clinicopathological factors.ResultsUnivariate analysis revealed that patient prognosis was associated with the size, shape, necrosis or cystic degeneration, margin, growth pattern, enhancement pattern, mitotic rate, and Ki-67 index of the tumor. Further, multivariate analysis indicated that tumor size and necrosis or cystic degeneration were significant independent prognostic factors for gastric GISTs.ConclusionsTumor shape, necrosis or cystic degeneration, growth pattern, enhancement pattern, and mitotic rate were non-negligible criteria for improving the prognostic accuracy for GISTs, whereas tumor size, margin, and Ki-67 index were significant independent predictors identifying high-risk patients, facilitating personalized treatment to improve the prognosis of gastric GISTs patients. Thus, a combination of MSCT findings and clinicopathological features may be a valuable tool for assessing the prognosis of patients with gastric GISTs.

Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs)

BackgroundThe aim of the present study was to evaluate the safety of endoscopic surgery, the clinicopathological features, and prognoses of small gastric gastrointestinal stromal tumors (GISTs). MethodsSmall gastric GIST patients (diameter: 0.10–2.00 cm) resected endoscopically in Zhongshan Hospital were retrospectively identified and clinicopathological features and outcomes were collected. The relationship between clinicopathological characteristics and tumor recurrence was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal tumor diameter for predicting malignant potential. ResultsAll lesions were completely removed by endoscopy and En bloc resection was 98.5%. The most frequent location was the gastric fundus (60.3%) and the average diameter of all lesions was 1.20 cm (range: 0.10–2.00 cm). Mitoses were calculated as more than 5/50 HPF in 44 (6.8%) patients and nuclear atypia was moderate in 243 (37.5%) patients, severe in 1 (0.2%). Necrosis, mucosal infiltration, and vascular infiltration were detected in 8 (1.2%), 5 (0.7%), and 3 (0.5%) patients, respectively. Tumor size was positively correlated with mitotic index (P < 0.001) and nuclear atypia (P < 0.001). After a median follow-up of 54 months, four patients were confirmed local recurrence. ROC curve analysis identified 1.45 cm as the best cut-off value to predict malignant potential (95% CI: 0·694–0·774). Survival analysis showed that patients with tumor diameters larger than 1.45 cm were associated with more local recurrences after resection (P = 0.011). ConclusionsEndoscopic surgery is feasible and safe for small gastric GISTs, especially those in favorable locations. Small gastric GISTs bear a good prognosis as a whole but those with diameters larger than 1.45 cm should receive more intensive surveillance or undergo endoscopic surgery.

Suggested cutoff tumor size for small gastric gastrointestinal stromal tumors

Background: To investigate if there is an appropriate cutoff tumor size for small gastric gastrointestinal stromal tumors (GISTs) or not, and whether the cutoff size could be used to predict the tumor progression for small gastric GISTs during follow-up. Methods: From May 2010 to March 2014, 97 patients were enrolled in the present study, including 90 small gastric GIST patients underwent resection, and 7 endoscopic ultrasound (EUS) suspected small gastric GIST patients. The cutoff tumor size of small gastric GISTs was calculated based on mitotic index using receiver operating characteristic (ROC) analysis. Results: Of the 90 patients, mitotic index of 18 small gastric GISTs (20%) exceeded 5/50 HPF. Using ROC analysis, we found that 1.4 cm may be considered as an appropriate cutoff tumor size. The ratio of CT enhancement, tumor ulceration, mitotic index exceeds 5/50 HPF and low risk category was significantly higher in tumors between 1.4 and 2.0 cm than that of tumors less than 1.4 cm (all P<0.05). EUS suspected small gastric GISTs between 1.4 and 2.0 cm showed significant tumor progression during follow-up (median 11.8 months, range from 10.1 to 24.5 months). Conclusions: The 1.4-cm may be considered as a more reasonable cutoff tumor size for small gastric GISTs. We recommended that all small gastric GISTs should be resected once diagnosed, at least for tumors between 1.4 and 2.0 cm.

Positive cyclin T expression as a favorable prognostic factor in treating gastric gastrointestinal stromal tumors.

Positive transcriptional elongation factor b (P-TEFb) contains the catalytic subunit cyclin-dependent kinase 9 (Cdk9) and the regulatory subunit cyclin T. Cyclin T1 and Cdk9 are the key factors of the PTEFb pathways and are overexpressed in the human head and neck carcinoma cell line. However, there have been limited studies regarding the role of cyclin T1 and Cdk9 in gastric gastrointestinal stromal tumors (GISTs). The aim of the present study was to assess the association between cyclin T1 and Cdk9 and their clinical significance in gastric GISTs. A total of 30 gastric GIST patients who underwent either laparoscopic or laparotomic partial gastrectomy were enrolled in the study. The surgical tissue slides were stained with Cdk9 and cyclin T1 antibodies, and the immunohistochemistry scores and disease-free survival (DFS) were analyzed. Ten patients were cyclin T1-positive, and 20 were negative. All 11 patients with recurrent tumors or distant metastases were cyclin T1-negative patients. Old age, large tumor size, a high Ki67 IHC staining score, high mitotic count and negative cyclin T1 staining revealed a worse clinical outcome in univariate analysis. By contrast, the Cdk9 score was not associated with clinical parameters. The Kaplan-Meier survival curve illustrated that the DFS rate of the patients with negative cyclin T1 staining was significantly lower than that of the patients with positive cyclin T1 staining. Positive expression of cyclin T1 was a good prognostic factor in patients with gastric GISTs.

Comparison of Endoscopic and Open Resection for Small Gastric Gastrointestinal Stromal Tumor

The National Comprehensive Cancer Network recommends conservative follow-up for gastric gastrointestinal stromal tumors (GISTs) less than 2 cm. We have previously reported that the mitotic index of 22.22% of small gastric GISTs exceeded 5 per 50 high-power fields and recommended that all small gastric GISTs should be resected once diagnosed. The aim of the present study is to compare the safety and outcomes of endoscopic and open resection of small gastric GISTs. From May 2010 to March 2014, a total of 90 small gastric GIST patients were enrolled in the present study, including 40 patients who underwent surgical resection and 50 patients who underwent endoscopic resection. The clinicopathological characteristics, resection-related factors, and clinical outcomes were recorded and analyzed. The clinicopathological characteristics were comparable between the two groups except for tumor location and DOG-1 expression. Compared with the surgical resection group, the operation time was shorter (P = .000), blood loss was less (P = .000), pain intensity was lower (P < .05), duration of first flatus and defecation was shorter (P < .05), and medical cost of hospitalization was lower (P = .027) in the endoscopic resection group. The complications and postoperative hospital stay were comparable between the two groups. No in situ recurrence or liver metastasis was observed during follow-up. Endoscopic resection of small gastric GISTs is safe and feasible compared with surgical resection, although perforation could not be totally avoided during and after resection. The clinical outcome of endoscopic resection is also favorable.

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors

To investigate the feasibility and short-term efficacy of laparoscopic resection of primary localized gastric gastrointestinal stromal tumors (GIST) by comparing with open surgery. Clinicopathological data of 167 gastric GIST patients undergoing operation in Zhongshan Hospital from June 2008 to December 2013 were retrospectively analyzed, among whom 55 received laparoscopic surgery and 112 underwent open surgery for primary local gastric GIST. Efficacy of different size and different location of GIST was compared between laparoscopic and open groups. There was no conversion to open surgery in laparoscopy group. Compared with open surgery, laparoscopic resection for gastric GIST smaller than 5 cm or located at anterior wall, greater curvature, lesser curvature, was associated with similar operation time(P>0.05), but less blood loss, shorter post-hospital stay or flatus time(all P<0.05). The operative outcomes were similar between laparoscopic and open resection for gastric GIST bigger than or equal to 5 cm or located at posterior wall(all P>0.05), except the longer operation time in laparoscopy group(P<0.05). The incidence of postoperative complication did not differ between two groups. Laparoscopic group had 2 patients with gastroparesis and open group had 2 gastroparesis, 2 pulmonary infection, and 1 poor wound healing(all P>0.05), which all recovered after conservative treatment. During 7 to 84 months(median 35) of follow-up, no recurrence or hepatic metastasis was found in laparoscopy group, and 3 hepatic metastases in open group. There was no significant difference of recurrence-free survival between two groups(P>0.05). Laparoscopic resection for gastric GIST is safe and effective in selected patients, especially for those with tumors smaller than 5 cm, or located at anterior wall, greater curvature, lesser curvature, whose short-term outcomes are better than open resection.

Prognostic Factors of Patients with Gastric Gastrointestinal Stromal Tumor after Curative Resection: A Retrospective Analysis of 406 Consecutive Cases in a Multicenter Study

Background/Purpose: Gastric gastrointestinal stromal tumors (GISTs) have a highly variable clinical course, and recurrent disease sometimes develops despite curative surgery. This study was undertaken to investigate the surgical role in treating gastric GISTs and evaluate the clinicopathological features of a large series of patients who underwent curative resection for gastric GISTs to clarify which features were independent prognostic factors. Methods: The clinicopathological data of 406 patients with gastric GISTs who underwent curative resection at 4 university hospitals in Daegu, South Korea, from March 1998 to March 2012 were reviewed. All cases were confirmed as gastric GISTs by immunohistochemical staining, in which CD117 or CD34 was positive. Clinical follow-up was performed periodically, and disease-free survival rates were retrospectively investigated using the medical records. Results: The mean follow-up period was 42.9 months (range: 2-166). There were 11 recurrent patients (2.7%). Due to the small number of recurrences, age, sex and location were controlled using propensity score matching before performing any statistical analysis. Tumor size, mitotic count, NIH classification, and cellularity were judged to be independent prognostic factors for recurrence by univariate analysis. In a multivariate analysis, tumor size and mitotic count were significantly and independently related to recurrence, and tumor size was determined to be the most important prognostic factor for recurrence after curative resection (hazard ratio: 1.204; p < 0.01). Conclusions: The results of this multicenter study demonstrate that disease-free survival rates are good. Tumor size was disclosed as the most important factor for recurrence in gastric GIST patients who underwent radical resection.

Efficacy analysis of endoscopic submucosal excavation for gastric gastrointestinal stromal tumors

To assess the efficacy and safety of endoscopic submucosal excavation(ESE) for gastric gastrointestinal stromal tumors(GISTs). Clinical data of 86 gastric GISTs patients undergoing ESE in our department from January 2007 to January 2013 were analyzed retrospectively. The whole tumor biopsy was used to determine the risk stratification. Complication of ESE was recorded and recurrence was investigated during regular follow-up. Tumors of all 86 cases were resected completely without residue proved by postoperative pathology. According to NIH risk stratification, 12 cases were very low risk, 30 low risk, 25 moderate risk, and 19 high risk. Tumor size, tumor depth, and tumor surface bleeding or edema were associated with the risk stratification of the GISTs(all P<0.05). Bleeding rate of ESE was 5.8%(5/86), including severe intraoperative bleeding in 1 case, postoperative delayed bleeding in 4 cases. The maximal tumor diameter was <2 cm in 1 case and >2 cm in 4 cases. The tumor were grade as moderate risk in 3 cases and high risk in 2 cases. The perforation rate was 10.5%(9/86), including tumors with a maximal diameter of <2 cm in 4 cases and >2 cm in 5 cases. The tumors were grade as moderate risk in 5 cases and high risk in 4 cases. Recurrence rate was 5.8%(5/86), including tumors with a maximal diameter <2 cm in 2 case and >2 cm in 3 cases. The tumors were grade as moderate risk in 4 cases and high risk in 1 cases. ESE is safe and effective for the treatment of gastric GISTs. The operative complication and postoperative recurrence may be associated with the tumor risk stratification.