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

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The 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).

Methods

Small 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.

Results

All 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).

Conclusions

Endoscopic 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.

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References

  1. Corless CL, Barnett CM, Heinrich MC: Gastrointestinal stromal tumours: origin and molecular oncology. Nature Reviews Cancer 2011, 11(12):865–878.

    Article  CAS  Google Scholar 

  2. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M et al: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science (New York, NY) 1998, 279(5350):577–580.

    Article  CAS  Google Scholar 

  3. Rossi S, Gasparotto D, Toffolatti L, Pastrello C, Gallina G, Marzotto A, Sartor C, Barbareschi M, Cantaloni C, Messerini L et al: Molecular and clinicopathologic characterization of gastrointestinal stromal tumors (GISTs) of small size. The American Journal of Surgical Pathology 2010, 34(10):1480–1491.

    Article  Google Scholar 

  4. Kawanowa K, Sakuma Y, Sakurai S, Hishima T, Iwasaki Y, Saito K, Hosoya Y, Nakajima T, Funata N: High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol 2006, 37(12):1527–1535.

    Article  Google Scholar 

  5. George D., Demetri M: NCCN Task Force Report: Update on the Management of Patients with Gastrointestinal Stromal Tumors. 2010.

  6. von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Conrad EU, III, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ et al: Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2016, 14(6):758–786.

    Article  Google Scholar 

  7. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology : official journal of the European Society for Medical Oncology 2014, 25 Suppl 3:iii21–26.

  8. Melstrom LG, Phillips JD, Bentrem DJ, Wayne JD: Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. American Journal of Clinical Oncology 2012, 35(5):451–454.

    Article  Google Scholar 

  9. Yang J, Feng F, Li M, Sun L, Hong L, Cai L, Wang W, Xu G, Zhang H: Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors. World Journal of Surgical Oncology 2013, 11:273.

    Article  Google Scholar 

  10. Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, Chen WF, Zhang YQ, Qin WZ, Hu JW et al: Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surgical Endoscopy 2011, 25(9):2926–2931.

    Article  Google Scholar 

  11. Zhang Y, Ye LP, Zhu LH, Zhou XB, Mao XL, Ding JX: Endoscopic muscularis excavation for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. Digestive Diseases and Sciences 2013, 58(5):1335–1340.

    Article  Google Scholar 

  12. Li J, Ye Y, Wang J, Zhang B, Qin S, Shi Y, He Y, Liang X, Liu X, Zhou Y et al: Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor. Chinese Journal of Cancer Research = Chung-kuo yen cheng yen chiu 2017, 29(4):281–293.

    Article  Google Scholar 

  13. Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, Zheng J, Zhang B, Tzen CY, Yeh CN et al: Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor. Cancer Research and Treatment : official journal of Korean Cancer Association 2016, 48(4):1155–1166.

    Article  Google Scholar 

  14. Hou YY, Lu SH, Zhou Y, Qi WD, Shi Y, Tan YS, Zhu XZ: Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors. Modern Pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2009, 22(4):556–569.

    Article  CAS  Google Scholar 

  15. Miettinen M, Lasota J: Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Archives of Pathology & Laboratory Medicine 2006, 130(10):1466–1478.

    CAS  Google Scholar 

  16. Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG: Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 2005, 103(4):821–829.

    Article  Google Scholar 

  17. Muenst S, Thies S, Went P, Tornillo L, Bihl MP, Dirnhofer S: Frequency, phenotype, and genotype of minute gastrointestinal stromal tumors in the stomach: an autopsy study. Hum Pathol 2011, 42(12):1849–1854.

    Article  Google Scholar 

  18. von Mehren M, Benjamin RS, Bui MM, Casper ES, Conrad EU, 3rd, DeLaney TF, Ganjoo KN, George S, Gonzalez R, Heslin MJ et al: Soft tissue sarcoma, version 2.2012: featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network: JNCCN 2012, 10(8):951–960.

    Article  Google Scholar 

  19. Wang YP, Li YI, Song C: Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach. Oncol Lett 2015, 10(5):2723–2730.

    Article  CAS  Google Scholar 

  20. Feng F, Liu Z, Zhang X, Guo M, Xu G, Ren G, Hong L, Sun L, Yang J, Zhang H: Comparison of Endoscopic and Open Resection for Small Gastric Gastrointestinal Stromal Tumor. Translational Oncology 2015, 8(6):504–508.

    Article  Google Scholar 

  21. Wang H, Feng X, Ye S, Wang J, Liang J, Mai S, Lai M, Feng H, Wang G, Zhou Y: A comparison of the efficacy and safety of endoscopic full-thickness resection and laparoscopic-assisted surgery for small gastrointestinal stromal tumors. Surgical Endoscopy 2016, 30(8):3357–3361.

    Article  Google Scholar 

  22. Meng FS, Zhang ZH, Hong YY, Li DJ, Lin JQ, Chen X, Ji F: Comparison of endoscopic submucosal dissection and surgery for the treatment of gastric submucosal tumors originating from the muscularis propria layer: a single-center study (with video). Surgical Endoscopy 2016, 30(11):5099–5107.

    Article  Google Scholar 

  23. Andalib I, Yeoun D, Reddy R, Xie S, Iqbal S: Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surgical Endoscopy 2017, 32(4):1787–1972.

    Article  Google Scholar 

  24. An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, Wang D, Li ZS, Shi XG: Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surgical Endoscopy 2017, 31(11):4522–4531.

    Article  Google Scholar 

  25. Meng Y, Li W, Han L, Zhang Q, Gong W, Cai J, Li A, Yan Q, Lai Q, Yu J et al: Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm. J Gastroenterol Hepatol 2017, 32(10):1693–1697.

    Article  Google Scholar 

  26. Andalib I, Yeoun D, Reddy R, Xie S, Iqbal S: Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surgical Endoscopy 2018, 32(4):1787–1792.

    Article  Google Scholar 

  27. Zhang B, Huang LY, Wu CR, Cui J, Jiang LX, Zheng HT: Endoscopic full-thickness resection of gastric stromal tumor arising from the muscularis propria. Chinese Medical Journal 2013, 126(13):2435–2439.

    CAS  PubMed  Google Scholar 

  28. Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY: Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surgical Endoscopy 2014, 28(2):524–530.

    Article  Google Scholar 

  29. Huang LY, Cui J, Lin SJ, Zhang B, Wu CR: Endoscopic full-thickness resection for gastric submucosal tumors arising from the muscularis propria layer. World Journal of Gastroenterology 2014, 20(38):13981–13986.

    Article  Google Scholar 

  30. Gao Z, Wang C, Xue Q, Wang J, Shen Z, Jiang K, Shen K, Liang B, Yang X, Xie Q et al: The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors. BMC Gastroenterology 2017, 17(1):8.

    Article  Google Scholar 

  31. Coe TM, Fero KE, Fanta PT, Mallory RJ, Tang CM, Murphy JD, Sicklick JK: Population-Based Epidemiology and Mortality of Small Malignant Gastrointestinal Stromal Tumors in the USA. J Gastrointest Surg 2016, 20(6):1132–1140.

    Article  Google Scholar 

  32. Fang YJ, Cheng TY, Sun MS, Yang CS, Chen JH, Liao WC, Wang HP: Suggested cutoff tumor size for management of small EUS-suspected gastric gastrointestinal stromal tumors. J Formos Med Assoc 2012, 111(2):88–93.

    Article  Google Scholar 

  33. Huang Z, Li Y, Zhao H, Zhao JJ, Cai JQ: Prognositic factors and clinicopathologic characteristics of small gastrointestinal stromal tumor of the stomach: a retrospective analysis of 31 cases in one center. Cancer Biology & Medicine 2013, 10(3):165–168.

    CAS  Google Scholar 

  34. Nishida T, Goto O, Raut CP, Yahagi N: Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 2016, 122(20):3110–3118.

    Article  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81773080) and Shanghai Municipal Commission of Health and Family Planning, Key-developing discipline (No. 2015ZB0201).

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Author notes

  1. Mincong Wang and Anwei Xue contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Mincong Wang, Anwei Xue, Xiaodong Gao, Min Fu, Yong Fang, Li Wang, Ping Shu, He Li, Kuntang Shen, Yinghong Sun & Xinyu Qin

  2. Department of Pathology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Wei Yuan & Yingyong Hou

Authors
  1. Mincong Wang
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  2. Anwei Xue
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  3. Wei Yuan
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  5. Min Fu
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  7. Li Wang
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  9. He Li
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  11. Kuntang Shen
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Contributions

(I) Conception and design: Mincong Wang, Anwei Xue, Xiaodong Gao

(II) Administrative support: Yingyong Hou, Kuntang Shen, Yihong Sun, Xiaodong Gao, Xinyu Qin

(III) Provision of study materials or patients: Yingyong Hou, Kuntang Shen, Yihong Sun, Xinyu Qin

(IV) Collection and assembly of data: Mincong Wang, Min Fu, Li Wang

(V) Data analysis and interpretation: Mincong Wang, Yong Fang, Wei Yuan, Ping Shu, He Li

(VI) Manuscript writing: All authors

(VII) Final approval of manuscript: All authors

Corresponding author

Correspondence to Kuntang Shen.

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Wang, M., Xue, A., Yuan, W. et al. Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Surg 23, 2136–2143 (2019). https://doi.org/10.1007/s11605-018-04070-3

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  • DOI: https://doi.org/10.1007/s11605-018-04070-3

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