This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (112)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology, Other  • Surgical Oncology  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

An Evaluation of 2537 Gastrointestinal Stromal Tumors for a Proposed Clinical Staging System
Woodall et al.
Arch Surg 2009;144:670-678.
ABSTRACT | FULL TEXT  

Sorafenib induces growth suppression in mouse models of gastrointestinal stromal tumor
Huynh et al.
Molecular Cancer Therapeutics 2009;8:152-159.
ABSTRACT | FULL TEXT  

Metastatic Gastrointestinal Stromal Tumors in the Era of Imatinib: Improved Survival and Elimination of Socioeconomic Survival Disparities
Artinyan et al.
Cancer Epidemiol. Biomarkers Prev. 2008;17:2194-2201.
ABSTRACT | FULL TEXT  

Diagnosis and Treatment of Gastrointestinal Stromal Tumors of the Stomach: Report of 28 Cases.
Wu et al.
Annals of Clinical & Laboratory Science 2007;37:15-21.
ABSTRACT | FULL TEXT  

Management of Gastrointestinal Stromal Tumors in the Imatinib Era: Selected Case Studies
Benjamin et al.
The Oncologist 2006;11:9-20.
ABSTRACT | FULL TEXT  

Gastrointestinal Stromal Tumors Express ras Oncogene: A Potential Role for Diagnosis and Treatment
Blair et al.
Arch Surg 2005;140:543-548.
ABSTRACT | FULL TEXT  

Segmental Resection of the Third Portion of the Duodenum for a Gastrointestinal Stromal Tumor: a Case Report
Sakamoto et al.
Jpn J Clin Oncol 2003;33:364-366.
ABSTRACT | FULL TEXT  

A Phase II and Pharmacokinetic Study of Ecteinascidin 743 in Patients with Gastrointestinal Stromal Tumors
Ryan et al.
The Oncologist 2002;7:531-538.
ABSTRACT | FULL TEXT