Gastric Stromal Tumors Research Articles

Submucosal 1-tunnel endoscopic resection for treating upper gastrointestinal multiple submucosal tumor originating from the muscularis propria layer: A report of 12 cases.

To explore the feasibility and efficacy of submucosal 1-tunnel endoscopic resection (1-tunnel STER) for the treatment of multiple upper gastrointestinal submucosal tumors (GI-SMTs) originating from the muscularis propria (MP) layer.A total of 12 patients with multiple upper GI-SMTs (no less than 2 SMTs) who underwent 1-tunnel STER from April 2013 to October 2017 were included. Clinical data on general characteristics, operation-related parameters, adverse events, and follow-up results were recorded and analyzed.All 12 patients underwent 1-tunnel STER successfully, and the mean operation time was 92.1 ± 40.8 minutes. A total of 30 SMTs were resected, out of which 27 were in the esophagus and 3 were in the stomach. The mean diameter was 15.0 ± 8.2 mm (range, 3–38 mm). All the SMTs were resected en bloc uneventfully. The SMTs comprised 28 leiomyomas and 2 gastric stromal tumors (low risk). No recurrence was noticed during a mean follow-up of 24.9 ± 15.3 months (range, 1–52 months).One-tunnel STER may serve as a feasible and effective technique for the treatment of multiple upper GI-SMTs originating from the MP layer. A large-scale prospective study is warranted for a confirmative conclusion.

Effectiveness of laparoscopic surgery in patients with large gastric GIST (diameter > 5cm).

35 Background: Recently, the application of laparoscopic or DaVinci surgery in relatively small gastrointestinal stromal tumors (GIST) has been increasingly recognized. However, the use in large stromal tumors, especially with a diameter greater than 5 cm, remains controversial for fear of tumor rupture. The aim of our study is to observe the effectiveness of laparoscopic approach in treatment of large gastric GIST. Methods: Patients who were diagnosed with gastric GIST (diameter > 5cm) at Xuanwu Hospital, China and underwent laparoscopic surgery from May 2011 to May 2018 were assessed. We set intraoperative tumor rupture as primary outcome. Secondly outcomes were conversion rate, operating time, estimated blood loss, length of postoperative hospital stay and recurrence rate at the end of the follow-up. Results: Fourty patients were included in our study with tumor size (7.54 ty-tw) cm (range, 5.0~13.8 cm). There was no intraoperative tumor rupture occurred. The median duration of operation was (76.3±29.9) minutes with estimated blood loss (28.7±15.2) mL. The median time for length of postoperative hospital stay was (5.8±4.1) days. The follow-up period for all the patients was 23.1 months (range, 2.4~51months). No local or distant recurrence was observed. Conclusions: Laparoscopic resection for large gastric GIST is feasible and effective. Laparoscopic surgery can substitute for open surgery as standard approach for gastric stromal tumors.

Clinical value of endoscopic treatment for small gastric stromal tumor

Objective To re-evaluate the potential risk of small gastric stromal tumor (diameter less than 2 cm), and to assess the safety and efficacy of endoscopic resection and further treatment strategy for small gastric stromal tumor. Methods Data of 584 patients undergoing endoscopic submucosal dissection (ESD) and diagnosed as gastric submucosal tumor (SMT) in Tianjin Medical University General Hospital from September 2008 to December 2015 were retrospectively analyzed. The clinical and pathological features and potential risk of small gastric stromal tumor were analyzed. The therapeutic outcomes, complications and follow-up results of ESD were summarized, and the follow-up results of patients undergoing ESD were compared with 45 patients who were suspected as small gastric stromal tumor and followed-up regularly by endoscopic ultrasonography (EUS) in the same period. Results Among 584 cases of gastric SMT, stromal tumor (239 cases, 40.9%) was the most common type, of which small gastric stromal tumor was found in 203 cases (84.9%, 203/239). The mitotic index of all cases was no more than 5/50 high power field. However, adverse factors under EUS, mainly including strong echo and heterogeneity, were reported in 94 (46.3%) out of 203 cases and were confirmed to be related to tumor size (P=0.000). ESD was successfully performed in 203 patients with small gastric stromal tumor, and no serious complication or perioperative death occurred. Symptoms of 81.4% (144/177) patients were improved after ESD, and no stromal tumor recurrence or metastasis was observed during a follow-up of 12-84 months. Of the 45 patients followed-up regularly by EUS, 38 (84.4%) patients had gastrointestinal symptoms and 84.2% (32/38) were not relieved during follow-up, and 12 (26.7%) had a heavier psychological burden, seriously affecting the quality of life. Conclusion The incidence of adverse factors under EUS is high in patients with small gastric stromal tumor, and increased with tumor size. ESD is safe and effective for small gastric stromal tumor, which contributes to the diagnosis, further improves therapeutic effects and reduces psychological pressure. Key words: Stomach neoplasms; Small gastric stromal tumor; Potential risk; Endoscopic resection

Clinicopathological characteristics and prognosis of primary appendiceal stromal tumors

BackgroundGastrointestinal stromal tumors (GISTs) account for less than 1% of all gastrointestinal tumors. The biological behaviors of GISTs vary from benign to malignant. GISTs are common in the stomach (55.6%) and small intestine (31.8%), but rarely in the rectum, colon (6%), and other sites (5.5%). Currently, the majority of published reports of primary appendiceal stromal tumors (PASTs) are case reports or case series.MethodsThe PASTs described in this study were identified from a literature review (23 cases) and our center (one case). The relationship between PAST gross types and clinicopathological factors was analyzed and summarized. At the same time, the study also analyzed the related risk factors and survival of PASTs and GISTs.ResultsTwenty-four cases of PASTs were compared with 254 cases of GISTs from our center. The results showed that there was a significant difference between the two groups in tumor size (P < 0.001), histological type (P = 0.013), CD34 expression (P < 0.001), and DOG-1 expression (P < 0.001). Disease-free survival (DFS) analysis of 11 cases of PASTs and 227 cases of GISTs found that a comparison of 3-year and 5-year DFS was not statistically significant (P = 0.894 and P = 0.846, respectively). In the DFS multivariate analysis, tumor mucosal ulceration, tumor size, and NIH risk classification were independent prognostic factors in 3-year and 5-year DFS.ConclusionIn this study, there was no significance in the survival of patients with appendix and gastric stromal tumors, which we hypothesized to be associated with the low sample size and incomplete follow-up records. Based on this, we conclude that the prognosis of primary appendiceal stromal tumors may be better than gastric tumors, but this needs to be confirmed in further prospective studies.

Computed tomography and magnetic resonance imaging features of regional portal hypertension

Computed tomography and magnetic resonance imaging features of regional portal hypertension

ASO Author Reflections: The Significance of Tumor Rupture in Gastric Gastrointestinal Stromal Tumors.

ASO Author Reflections: The Significance of Tumor Rupture in Gastric Gastrointestinal Stromal Tumors.

Short-term effect analysis of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor

Objective To compare the short-term clinical effects of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST). Methods The retrospective cohort study was conducted. The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People′s Liberation Army from June 2016 to May 2018 were collected. Of 98 patients, 45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group. The associate senior and above doctors performed the surgery. The wedge resection was applied to patients with diameter of gastric stromal tumor 5 cm or tumor located in the cardia and pylorus. Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018. Measurement data with normal distribution were represented as ±s, and comparison between groups was done using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using nonparametric test. Comparisons of count data were analyzed using chi-square test. Results (1) Surgical and postoperative situations: 98 patients underwent successful surgery. The operation time, volume of intraoperative blood loss, recovery time of gastrointestinal function, time of gastrointestinal decompression tube removal, time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152±49)minutes, 100 mL (range, 10-300 mL), (2.6±0.6)days, (1.1±0.3)days, (5.7±1.2)days, (8.3±1.3)days in the robotic group and (201±62)minutes, 100 mL (range, 5-600 mL), (3.1±0.7)days, (2.1±1.5)days, (6.9±3.4)days, (11.6±7.0)days in the laparoscopic group, with statistically significant difference between groups (t=-3.983, Z=2.104, t=-3.776, -3.637, -2.018, -2.817, P<0.05). (2) Follow-up: 98 patients were followed up for 2-24 months, with a median time of 13 months. During the follow-up, there was no tumor recurrence or metastasis between groups. Conclusion Compared with laparoscopy-assisted surgery, Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible, with advantages of shorter operation time, faster postoperative recovery and shorter duration of hospital stay. Key words: Gastrointestinal stromal tumor; Surgical procedures, operative; Da Vinci robot; Laparoscopy; Efficacy

Imatinib mesylate preoperative treatment for gastrointestinal stromal tumors: clinical analysis of 12 cases

Objective Evaluation of imatinib mesylate treatment of unresectable/marginally resectable gastric and duodenal stromal tumors,as well as its side effect and the toxicity.Methods Oral imatinib mesylate was prescribed at the dose of 400 mg/d for 12 cases of patients with unresectable/marginally resectable gastric and duodenal stromal tumors.The evaluation of the adverse reactions was in accordance with United States NCI-CTC grading standards (3rd edition).Choi standard was used to evaluate the patients at 3 and 6 month time points.Results For hematological toxicity,only 1 case of patient with Ⅲ° decreased white blood cell count,and the rest patients were with Ⅰ° to Ⅱ ° degree.For nou-hematological toxicity,the author observed cardiac toxicity,liver function damage,renal function damage,diarrhea,abdominal pain,nausea/vomiting,fatigue,anorexia,muscle pain,rash,hair loss,skin and mucosa edema.Among them,there was only 1 patient with Ⅲ° skin rash,and 1 patient with Ⅲ° edema,all the rest were with Ⅰ° to Ⅱ °.Eight and 11 cases of patients were evaluated as partial remission (PR) after 3 and 9 months of treatment respectively.Among them,nine patients were given R0 resection and 2 patients denied surgery due to old ages.One patient was stable (SD).Conclusions Preoperative treatment of patients with unresectable/marginally resectable gastrointestinal stromal tumors by imatinib mesylate will increase the resection rate.The related toxicity can be well-tolerated. Key words: Stomach neoplasms; Imatinib mesylate; Treatment, preoperative

Importance of Early Diagnosis of Gastrointestinal Stromal Tumors of the Stomach: Our 5-Year, Single-Center Experience

Objective:The aim of this study was to investigate clinicopathologic characteristics, diagnosis, treatment, and prognosis of patients who underwent surgery with a diagnosis of a gastrointestinal stromal tumor (GIST) of the stomach.Methods:In this single center study, the data of a total of 42 patients diagnosed with a GIST of the stomach in our center between 2010 and 2015 were retrospectively analyzed. The mean age was 60.6 years, with a male-to-female ratio of 1.47/1. Patients presented with various complaints (21 patients had stomach pain,14 patients were asymptomatic, 3 patients had hemorrhage, 2 patients had heartburn and acidity,1 patient had intumescence,1 patient had nausea and vomiting), and all patients underwent surgery. The initial diagnosis was made with endoscopy in 19 patients, with computed tomography in 21 patients, and with magnetic resonance imaging in 2 patients. Local excision or wedge resection was performed in 27 patients, whereas subtotal gastrectomy was performed in 15 patients.Results:The mean tumor diameter was 5.66 cm. Pathologically, 25 patients had very low, 5 patients had low, 6 patients had moderate, and 6 patients had high-grade malignancy. The patients with moderate- to high-grade malignancy received imatinib. Liver metastasis occurred in 2 patients. The mean follow-up was 33 months. The mean disease-free survival time was 31.72 months, and the mean disease-specific (n = 2) survival time was 31.25 months. All patients including metastatic ones were still alive.Conclusions:Our study results show that frequent use of imaging studies and increased use of endoscopic scans for various reasons may increase the rate of incidentally detected gastric stromal tumors. High rates of disease-free survival can be achieved in GIST patients who are in the low-risk group due to the early diagnosis.

Clinical efficacy of endoscopic resection versus laparoscopic resection and open resection for gastric stromal tumor

Objective To investigate the clinical efficacy of endoscopic resection, laparoscopic resection and open resection in the treatment of gastric stromal tumor (GIST). Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 254 GIST patients who were admitted to the First Affiliated Hospital of Army Medical University between January 2007 and June 2017 were collected. The endoscopic submucosal dissection (ESD) and laparoscopic or open wedge resection of GIST were performed according to the patients′ conditions. Observation indicators: (1) surgical and postoperative recovery situations; (2) postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to June 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Surgical and postoperative recovery situations: of 254 patients, 112 underwent ESD, including 111 with successful operation and 1 with intraoperative conversion to open surgery due to excessive bleeding-induced blurred operating view, 93 underwent successful laparoscopic wedge resection of GIST and 49 underwent successful open wedge resection of GIST. The operation time, volume of intraoperative blood loss, time for initial fluid diet intake, duration of hospital stay and hospital expenses were respectively (75±21) minutes, (6.9±0.5)mL, (2.8±0.9)days, (5.5 ± 0.2)days, (22 167±1 364)yuan in patients with ESD and (137±65)minutes, (48.1±2.6)mL, (3.9±1.4)days, (8.3 ± 2.2)days, (32 937±1 823)yuan in patients with laparoscopic operation and (168±60)minutes, (157.2±10.3)mL, (5.8±1.7)days, (11.3±3.5)days, (38 462±1 961) yuan in patients with open operation. Two patients with ESD had subcutaneous emphysema and didn′t receive special treatment, and then emphysema disappeared after 2 days. No complication was detected in patients with laparoscopic or open operations. (2) Postoperative pathological examination: tumor diameter in patients with ESD, laparoscopic operation and open operation was respectively (2.6±1.6)cm, (6.1±2.2)cm and (6.4±2.3)cm. The cases with positive CD117, discovered on GIST-1 (DOG1), CD34 and smooth muscle actin (SMA) were 106, 105, 86, 17 with ESD and 89, 87, 59, 11 with laparoscopic operation and 46, 47, 30, 8 with open operation, respectively. The extremely low risk, low risk, medium risk and high risk were respectively detected in 67, 42, 3, 0 patients with ESD and 16, 36, 23, 18 patients with laparoscopic operation and 7, 20, 14, 8 in patients with open operation. (3) Follow-up and survival situations: 210 of 254 patients were followed up for 6.0-120.0 months, with an average time of 36.0 months, including 86 with ESD, 82 with laparoscopic operation and 42 with open operation. During the follow-up, of patients with ESD, 3 patients with medium risk respectively received imatinib therapy for 7.0 months, 1.5 years and 2.0 years, and postoperative gastroscopy reexaminations every 6 months, without tumor recurrence; 81 with extremely low risk and low risk received postoperative gastroscopy reexaminations every 6 months and didn′t receive targeted therapy, without tumor recurrence; 2 died of non-stromal tumor. The postoperative average survival time, 1-, 3- and 5-year survival rates were respectively 56.3 months, 98.8%(81/82), 91.5%(75/82), 74.4% (61/82) in patients with laparoscopic surgery and 52.4 months, 97.6%(41/42), 85.7% (36/42), 81.0%(34/42) in patients with open surgery. Conclusions According to patients′ conditions, endoscopic resection, laparoscopic resection and open resection are safe and feasible in the treatment of GIST. Endoscopic resection of GIST should be selectively applied to patients with smaller diameter, with advantages of lower hospitalization expenses and better long-term prognosis. Key words: Gastric neoplasms; Stromal neoplasms; Endoscopic submucosal dissection; Surgical procedures, operative; Open resection; Laparoscopy

Gastric heterotopic pancreas and stromal tumors smaller than 3\xa0cm in diameter: clinical and computed tomography findings

BackgroundIdentifying gastric heterotopic pancreas and stromal tumors is difficult. Few studies have reported computed tomography (CT) findings for differentiating lesions less than 3 cm in diameter. In this study, we aimed to identify clinical characteristics and CT findings that can differentiate gastric heterotopic pancreatic lesions from stromal tumors less than 3 cm in diameter.MethodsA total of 132 patients with pathologically confirmed gastric heterotopic pancreas (n = 66) and stromal tumors (n = 66) were included. Each group was divided into primary (n = 50) and validation cohort (n = 16). Clinical characteristics and CT findings were retrospectively reviewed. CT findings included location, border, contour, growth pattern, enhancement pattern and grade, the enhancement value of tumor, enhancement ratio of tumor, and enhancement ratio of tumor to pancreas in venous phase. The findings in the two groups were compared using the Pearson χ2 test or Student t-test. Receiver operating characteristic curves were used to determine areas under the curve and optimal cut-offs.ResultsSignificant differences were observed between heterotopic pancreas and stromal tumors in the distribution of tumor location, border, contour (all P < 0.001), enhancement values (P < 0.001), enhancement ratios of tumors (P < 0.001), and enhancement ratios of tumors to pancreas (P < 0.001). No significant differences existed in growth pattern (P = 0.203). The area under the curve differed significantly between enhancement ratio of tumor to pancreas and enhancement ratio (P = 0.030). There were significant differences in above characteristics between two groups in validation cohort.ConclusionsHeterotopic pancreas has characteristic CT features differentiating it from stromal tumors.

Predictive Effect of Preoperative Platelet-lymphocyte Ratio on Prognosis of Patients with Gastric Stromal Tumor

Predictive Effect of Preoperative Platelet-lymphocyte Ratio on Prognosis of Patients with Gastric Stromal Tumor

Secreted protein acidic and rich in cysteine-like 1 suppresses metastasis in gastric stromal tumors

BackgroundMalignant growth and metastasis of gastrointestinal stromal tumors (GIST) occur in some patients even during the course of treatment, but their mechanisms remains poorly understand at the molecular level so far.MethodsProfiles of protein expression in gastric GIST tissues were explored using protein microarray analysis, down-regulation of SPARCL1 (secreted protein acidic and rich in cysteine-like protein 1) was validated by RT-qPCR, western blot and immunohistochemistry. The effect of specific shRNA-induced SPARCL1 downregulation on the biological traits of GIST 882 cell was investigated. We then employed a mouse xenograft model to investigate whether the low-expression of SPARCL1 impact the metastasis ability of GIST cells in vivo.ResultsSPARCL1 was significantly downregulated in the gastric GIST with high-grade malignance as compared with low-grade malignance, its expression was closely correlated with tumor size, mitotic index, distant metastasis at the time of initial diagnosis and tumor progression of GIST (P < 0.05). Moreover, results of the Cox analysis showed that expression of SPARCL1 is an independent prognostic predictors for gastric GIST (P = 0.008; HR 0.157, 95% CI 0.040~ 0.612). Downregulation of SPARCL1 promoted cell migration and invasion, but did not affect proliferation, cell cycle and apoptosis of GIST 882 cells. In mouse xenograft model, GIST cells with the decreased expression of SPARCL1 presented an enhanced ability of liver metastasis (P < 0.05).ConclusionsTaken together, our present study demonstrated that SPARCL1 have a certain degree of malignancy-suppressing potential through inhibiting the metastasis of gastric GIST.

Clinical Value of Multi-slice Spiral Enhanced CT in Diagnosing Mild Digestive Tract Hemorrhage

Objective To investigate the clinical value of multi-slice spiral CT(MSCT) in the diagnosis of mild digestive tract hemorrhage. Methods Thirty-five patients with mild gastrointestinal hemorrhage were examined by enhanced MSCT.CT signs were observed and compared with pathologic examination findings.Results Diseases in these 35 patients included gastric and duodenal ulcer and inflammation(n=4,11.4%),esophagogastric variceal rupture(n=7,20.0%),gastric carcinoma(n=3,8.6%),gastric stromal tumor(n=3,8.6%),gastric polyp(n=1,2.9%),colonic malignancy(n=5,14.2%),small intestinal stromal tumor(n=6,17.1%),rectal cancer(n=2,5.7%),intestinal Crohn disease(n=3,8.6%),and jejunum diverticulum combined with hemorrhage(n=1,2.9%).All of them were diagnosed by endoscopy of the digestive tract and confirmed by operation and pathology.The accuracy rate of CT was 100%.The coincidence rate of CT diagnosis was 97.1%.Conclusion MSCT is a promising technique in the localization,qualitative diagnosis,and clinical treatment of mild gastrointestinal hemorrhage.

Gastric stromal tumor with pregnancy: A case report

Gastrointestinal stromal tumorler (GIST) gastrointestinal sistemi duvarinda gelisen nadir mezenkimal tumorlerdir. Gebelikte GIST ile ilgili literaturde az miktarda bilgi bulunmaktadir. Biz burada gebelik ikinci trimesterde tespit edilen bir GIST olgusunu rapor ediyoruz. Olgu 44 yasinda ve hamileligin besinci ayindaydi. Biliyer kolik agrisi ile basvurdu. Abdominal muayenede 15 cm'lik rahim yuksekligi ve sag hypochondrium 15 cm kitle tespit edildi. Abdominal ultrasonografi ve manyetik rezonans goruntuleme ile sag hypochondrium bolgesinde buyuk bir lezyon gosterildi. Endoskopi ile midenin onunde dissal basi goruldu. Hasta ameliyata alindi ve orta hat kesi yapildi. Eksplorasyonda neredeyse tum sag hypochondrium isgal eden, karacigeri yukari ve rahimi asagi iten, kucuk kurvatur duzeyinde mideye yapisan, yaklasik 3 cm'lik bir implantasyon tabani olan 25 cm kitle tespit edildi. Histolojik ve immun histokimyasal calismalar, yuksek malignite riskli GIST gosterdi. Literaturde gebelik sirasinda sadece olgu sunumu olarak bildirilen GIST, multidisipliner bakim gerektiren nadir bir patolojidir.

Correlation between tumor diameter of small gastric stromal tumor and the biological characteristics

目的 探讨胃小间质瘤肿瘤直径与生物学特性的关系。 方法 分析山西省肿瘤医院2012年10月至2016年4月手术治疗的91例胃小间质瘤患者临床资料。根据肿瘤直径分为<1.0 cm（41例）、≥1.0 cm且<1.5 cm（28例）、≥1.5 cm且<2.0 cm（22例）三组，分析三组胃小间质瘤直径与生物学特性的关系。 结果 内镜下完整剥离91例，其中术中大出血中转开腹手术1列，穿孔11例，内镜下用金属钛夹或钛夹结合尼龙绳闭合穿孔。内镜手术成功率为98.90%（90/91），肿瘤完整切除率100%（91/91）。术后病理检查结果显示极低危组45例，低危组36例，中危组10例；Ki-67低表达67例，高表达20例，缺失4例。胃小间质瘤肿瘤直径大者，高危险度、Ki-67高表达的比例高；Ki-67高表达比例高者，危险度高。术后随访3~36个月，患者创面愈合情况良好，超声内镜检查未见复发。 结论 胃小间质瘤随着肿瘤直径的增大，恶性趋势增加，一经发现宜尽早切除。

A case of pyoderma gangrenosum on the abdomen after surgical excision of gastric stromal tumor

A case of pyoderma gangrenosum on the abdomen after surgical excision of gastric stromal tumor

Comparison of the real-world adherence and compliance patterns with trifluridine/tipiracil (FTD/TPI) and regorafenib (REG) for the treatment of metastatic colorectal cancer (mCRC).

666 Background: FTD/TPI and REG both prolong survival in refractory mCRC and have similar indications with different side effect profiles. This study compares real-world treatment patterns with FTD/TPI and REG for mCRC in a large, representative US claims database. Methods: Retrospective data from 10/2014 to 7/2016 from the US Symphony Health Solutions’ Integrated Dataverse (IDV®) database were analyzed for patients receiving FTD/TPI or REG. The index date was the date of first FTD/TPI or REG prescription. Patients were included if: 1) age ≥18 years old, 2) ≥1 CRC diagnosis, 3) no diagnosis of gastric cancer or gastrointestinal stromal tumor, and 4) continuous clinical activity for ≥3 months before and after index date. The observation period spanned from index date to end of data, end of continuous clinical activity, or switch to another mCRC treatment. Adherence was assessed using medication possession ratio (MPR) ≥0.80 and proportion of days covered (PDC) ≥0.80 at 3 months. Compliance was assessed using time to discontinuation over the observation period using allowable gaps of 45, 60, or 90 days. Patients who never discontinued therapy were censored at the end of the observation period. Outcomes were compared between FTD/TPI and REG using multivariate logistic regression and Cox proportional hazards models, adjusting for demographic and clinical baseline characteristics. Results: A total of 1,630 FTD/TPI patients and 1,425 REG patients were identified. Mean ± standard deviation (SD) age of FTD/TPI patients was 61.0 ± 11.0 compared to 62.8 ± 10.9 for REG patients (p &lt; 0.001). FTD/TPI patients were 80% more likely to have a MPR ≥0.80 compared to those on REG (Odds Ratio [OR] = 1.80, p &lt; 0.001) and more than twice as likely to have a PDC ≥0.80 (OR = 2.66, p &lt; 0.001) at 3 months. FTD/TPI patients were 37% less likely to discontinue their treatment compared to those on REG when using gaps of 60 days (Hazard Ratio = 0.63, p &lt; 0.001). Similar results were found with 45 and 90 days. Conclusions: In this retrospective study of mCRC patients, patients on FTD/TPI were significantly more likely to adhere and comply with therapy compared to those on REG.

Treatment of gastric gastrointestinal stromal tumor by laparoscopic sleeve gastrectomy in a morbidly obese patient

Treatment of gastric gastrointestinal stromal tumor by laparoscopic sleeve gastrectomy in a morbidly obese patient

Voluminous Gastric Stromal Tumors: Place of Surgery about 5 Cases at the Dakar Cancer Institute

Objectives: To describe the surgical and prognostic aspects of voluminous gastric stromal tumors at Joliot Curie Cancer Institute. Methods: This was a retrospective study of patients with voluminous stromal tumors from January 2010 to December 2015. Patients had a bulky gastric mass at the clinical examination and CT and had positive CD117 marker. Local stage and extension was evaluated and surgical treatment studied. Prognosis was also analyzed according to surgery and adjuvant treatment. Results: Five large GISTs were found. Most are women with a mean age of 39. The tumor was palpable in all patients. Other symptoms are pain and vomiting. Gastroscopy found a burgeoning tumor in 4 patients with external compression in 1 patient. Biopsy showed stromal tumor with fusiform cells in 3 patients and epithelioid cells in 2 patients. CD117 and CD34 were positive in all patients. Abdominal and thoracic CT showed a sus mesocolic mass voluminous with multi viscerl involvement without distant metastasis. Surgery consisted in all cases of total gastrectomy extended to the spleen, the tail of the pancreas, the colon and the liver. One patient died of postoperative peritonitis at day five. There was none other immediate post-operative complications. All patients received adjuvant treatment with Imatinib. After a 23-month follow-up, 1 patient experience important sarcopenia while 1 patient recurred to the liver and brain with resistance to Imatinib and second line Sunitinib and died. Conclusion: voluminous gastric GIST in Africa is characterized by young age and involvement of sus mesocolic organs. Surgery with Imatinib as first line adjuvant treatment showed good results.