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Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study

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Abstract

Background and aims

Gastrointestinal stromal tumors (GIST) are mostly seen in the stomach. Clinical data on GISTs ≤ 2 cm with > 5 mitosis/50 HPFs are limited. This study aimed to analyze small GISTs with high histological grades to gain a more comprehensive understanding of their clinical characteristics with long-term follow-up.

Methods

This was a nested cohort study of patients with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs. Individuals with endoscopically resected gastric specimens diagnosed as GISTs between January 2008 and July 2019 were enrolled. We analyzed baseline clinicopathological characteristics, perioperative characteristics, risk of recurrence, and metastasis during follow-up.

Results

A total of 55 patients diagnosed with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs were enrolled. The mean tumor size was 1.6 ± 0.4 cm (median 1.7 cm, range 0.8–2.0 cm). ESD was performed in 33 patients (60.0%) and EFTR in 22 patients (40.0%). Mean mitotic figures were 8.9/50 HPFs. Postoperative bleeding in one patient (1.8%) was the only severe adverse event. The mean follow-up period was 61.2 ± 33.9 months (median 53 months, range 13–133 months). Five patients (5/55, 9.1%) received additional therapies, including partial gastrectomy and adjuvant Imatinib. Only two patients (2/55, 3.6%) showed signs of recurrence. We observed no significant difference regarding baseline clinical characteristics and recurrence among GISTs with mitosis < 10/50 HPF and ≥ 10/50 HPF. No patient had signs of metastasis during follow-up.

Conclusion

Endoscopic resection of gastric GISTs ≤ 2 cm with > 5 mitosis/50 HPFs has a low risk of recurrence and metastasis in the long term. Endoscopic resection of GISTs is safe and feasible.

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Abbreviations

GIST:

Gastrointestinal stromal tumor

ESD:

Endoscopic submucosal dissection

EFTR:

Endoscopic full-thickness resection

HPF:

High power field

GI:

Gastrointestinal

NCCN:

National comprehensive cancer network

SEL:

Subepithelial lesion

ASGE:

American society of gastrointestinal endoscopy

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Author notes

  1. Tian-Yin Chen and Jia-Xin Xu have shared co-first authorship.

Authors and Affiliations

  1. Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Tian-Yin Chen, Jia-Xin Xu, Wei-Feng Chen, Quan-Lin Li, Ming-Yan Cai, Jian-Wei Hu, Wen-Zheng Qin, Xiao-Yue Xu, Yi-Qun Zhang & Ping-Hong Zhou

  2. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

    Yuan Ji

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  1. Tian-Yin Chen
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Contributions

TC and JX participated in the original draft preparation. WC, QL, MC, JH, WQ, and XX contributed to resources. YJ contributed to resources and methodology. YZ participated in the conceptualization, supervision, and reviewing and editing of the manuscript. PZ participated in the reviewing and editing of the manuscript.

Corresponding authors

Correspondence to Yi-Qun Zhang or Ping-Hong Zhou.

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Disclosures

Drs. Tian-Yin Chen, Jia-Xin Xu, Wei-Feng Chen, Quan-Lin Li, Ming-Yan Cai, Jian-Wei Hu, Wen-Zheng Qin, Yuan Ji, Xiao-Yue Xu, Yi-Qun Zhang, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose. All authors disclosed no financial relationships relevant to this publication.

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Chen, TY., Xu, JX., Chen, WF. et al. Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study. Surg Endosc 36, 4042–4049 (2022). https://doi.org/10.1007/s00464-021-08725-2

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