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Jean-Pierre E. N. Pierie, MD,PhD; Umar Choudry, MD; Alona Muzikansky, MA; Beow Yong Yeap, ScD; Wiley W. Souba, MD,ScD,MBA; Mark J. Ott, MD

Arch Surg. 2001;136:383-389.

Hypothesis  Gastrointestinal stromal tumors (GIST) are aggressive, rare, and difficult-to-cure gastrointestinal tumors. We believe that the clinical behavior of these tumors can be predicted by reproducible prognostic factors.

Design and Setting  A retrospective review of all patients (N = 70) with GIST treated at a tertiary care center from 1973 to 1998.

Patients  Adequate data for evaluation were available for 69 patients. Male-female distribution was 40:29. Median age was 60 years. Median follow-up duration was 38 months.

Main Outcome Measures  Tumor grade, stage, and histologic subtype at presentation; effect of grade, surgery and adjuvant therapy on recurrence, salvage, and survival.

Results  Tumor distribution included 61% in the upper, 23% in the middle, and 16% in the lower digestive tract, with a median tumor size of 7.9 cm (range, 1.8-25 cm). Tumors with more than 1 mitosis per 10 high-power fields constituted 57% of neoplasia in the series. Distant disease at initial visit occurred in 49% of patients. Complete gross resection occurred in 59% of patients. After complete resection, the 5-year survival rate was 42%, compared with 9% after incomplete resection (hazard ratio = 0.27, P<.001). Neither radiation nor chemotherapy demonstrated any significant benefit. Among 39 patients who were disease free after complete resection, 2% developed lymph node recurrence, 25% developed local recurrence, and 33% developed distant recurrences (54% liver, 20% peritoneum). By multivariate analysis the risk of local and/or distant metastases was significantly increased for tumors with more than 1 mitosis and size larger than 5 cm (P<.05). Multivariate analysis in all 69 patients revealed that incomplete resection, age greater than 50 years, non–smooth muscle histological feature, tumor with more than 1 mitosis, and tumor size larger than 5 cm significantly decreased survival.

Conclusion  Complete gross surgical resection is presently the only means of cure for GIST. Tumors with more than 1 mitosis and a size larger than 5 cm have an especially poor prognosis, with decreased survival, and increased local and/or distant recurrence.

From the Division of Surgical Oncology (Drs Pierie, Choudry, and Ott) and the Cancer Statistics Center (Ms Muzikansky and Dr Yeap), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Surgery, Penn State Giesinger Health System, Hershey, Pa (Dr Souba).

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