Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review
- 94 Downloads
Till present, there are still controversies over the epidemiology, pathological features, types of surgical treatment, and prognoses of primary small gastric GISTs (gGISTs).
From January 1998 to January 2015, patients with primary small gGIST admitted from four high-volume medical centers of the Southern China were enrolled and their data were analyzed to evaluate their clinicopathological features, treatment and prognostic factors to provide evidence-based medical experience for clinical practice.
A total of 276 primary small gGIST cases over a period of 18 years were investigated and had a median age of 60 years (range 27–91 years old). Regarding the tumor sites, 24 (8.7%) cases were in the cardia of the stomach, 107 (38.8%) in the fundus, 117 (42.4%) in the gastric body, and 28 (10.1%) in the gastric antrum. Eleven patients (4.0%) underwent a preoperative biopsy. A total of 137 (49.6%), 75 (27.2%), and 64 (23.2%) patients underwent laparoscopic, open resection, and endoscopic resection, respectively. Sixty-four patients (23.2%) had local endoscopic resection, 172 (62.3%) had wedge resection, 7 (2.5%) had proximal gastrectomy, 19 (6.9%) had distal gastrectomy, and 14 (5.1%) had total gastrectomy. Mitotic counts were ≤ 5/50, (5–10)/50, and > 10/50 per HPF in 259 (93.8%), 7 (2.5%), and 10 (3.6%) cases, respectively. There were 259 cases (97.1%) of spindle cell type, 7 (2.5%) epithelial cell types and one case (0.4%) of mixed type. Immunohistochemistry showed 74.6% (206/276), 98.2% (271/276), and 97.4% (269/276) of the patients had co-expression of CD34+, CD117+, and DOG-1+, respectively. Thirty-nine patients underwent genetic testing (39/276, 14.1%). Three patients (1.1%) had positive resection margin. Five high-risk patients received follow-up treatment with imatinib with a median follow-up time of 38 months (range 3–156 months). The overall 1-, 3-, and 5-year overall survival rates were 100%, 99.6%, and 99.1%, respectively.
Though the incidence of primary small gGISTs increased per annum, the overall survival prognoses were high. Surgery or endoscopic resection was the primary mode of treatment. Pathological features of primary small gGISTs were similar to large gGISTs, and to achieve a timely surgical intervention, the identification of intermediate- and high-risk cases should be a future focus of study.
KeywordsPrimary small gGIST Epidemiology Clinicopathological features Overall survival Prognosis
ZY, XF, PZ, TC, HQ, ZZ, GL, KXT, and YL have substantial contributions to the conception and design of this study, have revised its intellectual content, and have approved of the final submitted version.
This study is supported by Natural Science Foundation of Guangdong Province (2016A030310328).
Compliance with ethical standards
Drs. Zifeng Yang, Xingyu Feng, Peng Zhang, Tao Chen, Haibo Qiu, Zhiwei Zhou, Guoxin Li, Kaixiong Tao, and Yong Li have no conflicts of interest or financial ties to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Hartmann JT, Pink D, Ramadori G, Hohenberger P, Al-Batran SE, Schlemmer M, Bauer S, Wardelmann E, Nilsson B, Sihto H, Bono P, Kallio R, Junnila J, Alvegard T, Reichardt P (2016) Adjuvant imatinib for high-risk GI stromal tumor: analysis of a randomized trial. J Clin Oncol 34:244–250CrossRefGoogle Scholar
- 5.von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Conrad EU 3rd, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM 3rd, Koon H, Mayerson J, McCarter M, McGarry SV, Meyer C, O’Donnell RJ, Pappo AS, Paz IB, Petersen IA, Pfeifer JD, Riedel RF, Schuetze S, Schupak KD, Schwartz HS, Tap WD, Wayne JD, Bergman MA, Scavone J (2016) Soft tissue sarcoma, version 2.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 14:758–786CrossRefGoogle Scholar
- 10.Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw 8(Suppl 2):S1–S41 (quiz S42–S44)CrossRefGoogle Scholar
- 16.Balde AI, Chen T, Hu Y, Redondo NJ, Liu H, Gong W, Yu J, Zhen L, Li G (2017) Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study. Surg Endosc 31:843–851CrossRefGoogle Scholar
- 23.Corless CL, Ballman KV, Antonescu CR, Kolesnikova V, Maki RG, Pisters PW, Blackstein ME, Blanke CD, Demetri GD, Heinrich MC, von Mehren M, Patel S, McCarter MD, Owzar K, DeMatteo RP (2014) Pathologic and molecular features correlate with long-term outcome after adjuvant therapy of resected primary GI stromal tumor: the ACOSOG Z9001 trial. J Clin Oncol 32:1563–1570CrossRefGoogle Scholar
- 25.Huang HY, Shi JF, Guo LW, Bai YN, Liao XZ, Liu GX, Mao AY, Ren JS, Sun XJ, Zhu XY, Wang L, Song BB, Du LB, Zhu L, Gong JY, Zhou Q, Liu YQ, Cao R, Mai L, Lan L, Sun XH, Ren Y, Zhou JY, Wang YZ, Qi X, Lou PA, Shi D, Li N, Zhang K, He J, Dai M (2017) Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey. Chin J Cancer 36:41CrossRefGoogle Scholar
- 27.Molinas MN, Selcukbiricik M, Kanitez M, Yalcin S, Tural D, Erdamar S et al (2016) Clinical and pathological characteristics and their effect on survival in elderly patients with gastrointestinal stromal tumors. J BUON 21(2):360Google Scholar
- 28.Farag S, van Coevorden F, Sneekes E, Grunhagen DJ, Reyners AKL, Boonstra PA, van der Graaf WT, Gelderblom HJ, Steeghs N (2017) Elderly patients with gastrointestinal stromal tumour (GIST) receive less treatment irrespective of performance score or comorbidity—a retrospective multicentre study in a large cohort of GIST patients. Eur J Cancer 86:318–325CrossRefGoogle Scholar
- 29.Breccia M, Luciano L, Latagliata R, Castagnetti F, Ferrero D, Cavazzini F et al (2014) Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival. Leuk Res 38(10):1173–1176CrossRefGoogle Scholar
- 30.Guo LW, Huang HY, Shi JF, Lv LH, Bai YN, Mao AY, Liao XZ, Liu GX, Ren JS, Sun XJ, Zhu XY, Zhou JY, Gong JY, Zhou Q, Zhu L, Liu YQ, Song BB, Du LB, Xing XJ, Lou PA, Sun XH, Qi X, Wu SL, Cao R, Lan L, Ren Y, Zhang K, He J, Zhang JG, Dai M, Health Economic Evaluation Working Group CSPiUC (2017) Medical expenditure for esophageal cancer in China: a 10-year multicenter retrospective survey (2002–2011). Chin J Cancer 36:73CrossRefGoogle Scholar