Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review

  • Zifeng Yang
  • Xingyu Feng
  • Peng Zhang
  • Tao Chen
  • Haibo Qiu
  • Zhiwei Zhou
  • Guoxin Li
  • Kai Xiong TaoEmail author
  • Yong LiEmail author
  • China Gastrointestinal Stromal Tumor Study Group (CN-GIST)
2018 SAGES Oral



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.

Graphical Abstract


Primary small gGIST Epidemiology Clinicopathological features Overall survival Prognosis 


Author contributions

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Yan W, Zhang A, Powell MJ (2016) Genetic alteration and mutation profiling of circulating cell-free tumor DNA (cfDNA) for diagnosis and targeted therapy of gastrointestinal stromal tumors. Chin J Cancer 35:68CrossRefGoogle Scholar
  2. 2.
    Valsangkar N, Sehdev A, Misra S, Zimmers TA, O’Neil BH, Koniaris LG (2015) Current management of gastrointestinal stromal tumors: surgery, current biomarkers, mutations, and therapy. Surgery 158:1149–1164CrossRefGoogle Scholar
  3. 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
  4. 4.
    Nishida T, Goto O, Raut CP, Yahagi N (2016) Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 122:3110–3118CrossRefGoogle Scholar
  5. 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
  6. 6.
    Kanda T (2016) Is a “wait-and-see” policy the best for small gastric gastrointestinal stromal tumor (GIST)? Transl Gastroenterol Hepatol 1:1CrossRefGoogle Scholar
  7. 7.
    Gao Z, Wang C, Xue Q, Wang J, Shen Z, Jiang K, Shen K, Liang B, Yang X, Xie Q, Wang S, Ye Y (2017) The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors. BMC Gastroenterol 17:8CrossRefGoogle Scholar
  8. 8.
    Agaimy A, Wünsch PH, Hofstaedter F, Blaszyk H, Rümmele P, Gaumann A et al (2007) Minute gastric sclerosing stromal tumors (GIST tumorlets) are common in adults and frequently show c-KIT mutations. Am J Surg Pathol 31(1):113–120CrossRefGoogle Scholar
  9. 9.
    Mikami T, Nemoto Y, Numata Y, Hana K, Nakada N, Ichinoe M et al (2013) Small gastrointestinal stromal tumor in the stomach: identification of precursor for clinical gastrointestinal stromal tumor using c-kit and α-smooth muscle actin expression. Hum Pathol 44(12):2628–2635CrossRefGoogle Scholar
  10. 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
  11. 11.
    Abraham SC, Krasinskas AM, Hofstetter WL, Swisher SG, Wu TT (2007) “Seedling” mesenchymal tumors (gastrointestinal stromal tumors and leiomyomas) are common incidental tumors of the esophagogastric junction. Am J Surg Pathol 31:1629–1635CrossRefGoogle Scholar
  12. 12.
    Muenst S, Thies S, Went P, Tornillo L, Bihl MP, Dirnhofer S (2011) Frequency, phenotype, and genotype of minute gastrointestinal stromal tumors in the stomach: an autopsy study. Hum Pathol 42:1849–1854CrossRefGoogle Scholar
  13. 13.
    Giuliano K, Nagarajan N, Canner J, Najafian A, Wolfgang C, Schneider E et al (2017) Gastric and small intestine gastrointestinal stromal tumors: do outcomes differ? J Surg Oncol 115(3):351–357CrossRefGoogle Scholar
  14. 14.
    Chandrasekhara V, Ahmad NA (2011) EUS-guided fine needle aspiration of gastrointestinal stromal tumors: the GIST of the matter. Dig Dis Sci 56:1596–1598CrossRefGoogle Scholar
  15. 15.
    Huang ZG, Zhang XS, Huang SL, Yuan XG (2012) Endoscopy dissection of small stromal tumors emerged from the muscularis propria in the upper gastrointestinal tract: preliminary study. World J Gastrointest Endosc 4:565–570CrossRefGoogle Scholar
  16. 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
  17. 17.
    Xu C, Chen T, Hu Y, Balde AI, Liu H, Yu J, Zhen L, Li G (2017) Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc 31:374–381CrossRefGoogle Scholar
  18. 18.
    Feng F, Liu Z, Zhang X, Guo M, Xu G, Ren G, Hong L, Sun L, Yang J, Zhang H (2015) Comparison of endoscopic and open resection for small gastric gastrointestinal stromal tumor. Transl Oncol 8:504–508CrossRefGoogle Scholar
  19. 19.
    Chen QF, Huang CM, Lin M, Lin JX, Lu J, Zheng CH, Li P, Xie JW, Wang JB, Chen QY, Cao LL, Tu RH (2016) Short- and long-term outcomes of laparoscopic versus open resection for gastric gastrointestinal stromal tumors: a propensity score-matching analysis. Medicine 95:e3135CrossRefGoogle Scholar
  20. 20.
    Huang JL, Zheng ZH, Wei HB, Chen TF, Liu JP, Huang Y, Wei B, Fang JF (2017) Endoscopy-assisted laparoscopic resections for gastric gastrointestinal stromal tumors: a retrospective study. J Laparoendosc Adv Surg Tech A 27:110–114CrossRefGoogle Scholar
  21. 21.
    Kawanowa K, Sakuma Y, Sakurai S, Hishima T, Iwasaki Y, Saito K, Hosoya Y, Nakajima T, Funata N (2006) High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol 37:1527–1535CrossRefGoogle Scholar
  22. 22.
    Hwang SH, Park do J, Kim YH, Lee KH, Lee HS, Kim HH, Lee HJ, Yang HK, Lee KU (2009) Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus. Surg Endosc 23(9):1980–1987CrossRefGoogle Scholar
  23. 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
  24. 24.
    Eisenberg BL (2013) The SSG XVIII/AIO trial: results change the current adjuvant treatment recommendations for gastrointestinal stromal tumors. Am J Clin Oncol 36:89–90CrossRefGoogle Scholar
  25. 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
  26. 26.
    Rutkowski P, Bylina E, Lugowska I, Teterycz P, Klimczak A, Streb J, Czarnecka AM, Osuch C (2018) Treatment outcomes in older patients with advanced gastrointestinal stromal tumor (GIST). J Geriatr Oncol 9:520–525CrossRefGoogle Scholar
  27. 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. 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. 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. 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

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General Surgery, Guangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouPeople’s Republic of China
  2. 2.Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  3. 3.Department of General Surgery, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China
  4. 4.Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouPeople’s Republic of China

Personalised recommendations