Clinicopathological Features and Prognostic Factors of Rectal Gastrointestinal Stromal Tumors
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Abstract
Aim
Rectal gastrointestinal stromal tumor (GIST) was a rare disease. This study sought to summarize clinicopathological features and prognostic factors of rectal GISTs.
Methods
Clinicopathological characteristics and prognostic factors of rectal GISTs were investigated by reviewing patients undergoing curative resection at the Fudan University Shanghai Cancer Center between 1986 and 2010.
Results
Twenty-one patients, 15 male and 6 female, were included. The mean age of onset was 51 years. The most common initial presentation was hematochezia (7 cases). Eleven patients underwent radical resection, and the other 10 received local resection. No lymph node metastases were identified. All cases were positive for CD117. Seventeen patients were classified as high National Institutes of Health (NIH) risk category. The 5-year disease-free survival (DFS) and overall survival were 33 and 46 %, respectively. Fifteen cases had recurrence postoperatively. Both univariate and multivariate analyses demonstrated the NIH risk category (p = 0.028) and hematochezia symptom (p = 0.014) were independent prognostic factors of the DFS of patients.
Conclusions
Hematochezia was the most common initial symptom. Over 50 % of patients received radical surgery. More than 80 % of patients were at high NIH risk of recurrence. Hematochezia symptom and high NIH risk category indicated poor prognosis of rectal GISTs.
Keywords
Rectum Gastrointestinal stromal tumor Symptom Surgery RecurrenceNotes
Acknowledgment
The grant of National Natural Science Foundation of China (no. 81001055) is acknowledged.
Conflict of interest
None declared
Supplementary material
References
- 1.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: 821–9.PubMedCrossRefGoogle Scholar
- 2.Tryggvason G, Gislason HG, Magnusson MK, Jonasson JG. Gastrointestinal stromal tumors in Iceland, 1990–2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer 2005; 117: 289–93.PubMedCrossRefGoogle Scholar
- 3.Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005; 100: 162–8.PubMedCrossRefGoogle Scholar
- 4.Tryggvason G, Kristmundsson T, Orvar K, Jonasson JG, Magnusson MK, Gislason HG. Clinical study on gastrointestinal stromal tumors (GIST) in Iceland, 1990–2003. Dig Dis Sci 2007; 52: 2249–53.PubMedCrossRefGoogle Scholar
- 5.DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231: 51–8.PubMedCrossRefGoogle Scholar
- 6.Aparicio T, Boige V, Sabourin JC, Crenn P, Ducreux M, Le Cesne A, Bonvalot S. Prognostic factors after surgery of primary resectable gastrointestinal stromal tumours. Eur J Surg Oncol 2004; 30: 1098–103.PubMedCrossRefGoogle Scholar
- 7.Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008; 39: 1411–9.PubMedCrossRefGoogle Scholar
- 8.Miettinen M, Furlong M, Sarlomo-Rikala M, Burke A, Sobin LH, Lasota J. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 2001; 25: 1121–33.PubMedCrossRefGoogle Scholar
- 9.Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002; 33: 459–65.PubMedCrossRefGoogle Scholar
- 10.Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001; 136: 383–9.PubMedCrossRefGoogle Scholar
- 11.Roberts PJ, Eisenberg B. Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 2002; 38 Suppl 5: S37-8.PubMedCrossRefGoogle Scholar
- 12.Khalifa AA, Bong WL, Rao VK, Williams MJ. Leiomyosarcoma of the rectum. Report of a case and review of the literature. Dis Colon Rectum 1986; 29: 427–32.PubMedCrossRefGoogle Scholar
- 13.Eisenberg BL, Judson I. Surgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol 2004; 11: 465–75.PubMedCrossRefGoogle Scholar
- 14.Chen CW, Wu CC, Hsiao CW, Fang FC, Lee TY, Che FC, Tsai WC, Jao SW. Surgical management and clinical outcome of gastrointestinal stromal tumor of the colon and rectum. Z Gastroenterol 2008; 46: 760–5.PubMedCrossRefGoogle Scholar
- 15.Yao KA, Talamonti MS, Langella RL, Schindler NM, Rao S, Small WJ, Joehl RJ. Primary gastrointestinal sarcomas: analysis of prognostic factors and results of surgical management. Surgery 2000; 128: 604–12.PubMedCrossRefGoogle Scholar
- 16.Bdioui H, Jouini M, Bouzaiene H, Nouira K, Fteriche F, Ksantini R, Chebbi F, Kacem MJ, Ben SZ. [Gastrointestinal stromal tumours: clinical and therapeutic features. A report of 25 cases]. Tunis Med 2006; 84: 599–602.PubMedGoogle Scholar
- 17.Nowain A, Bhakta H, Pais S, Kanel G, Verma S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 2005; 20: 818–24.PubMedCrossRefGoogle Scholar
- 18.Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998; 228: 355–65.PubMedCrossRefGoogle Scholar
- 19.Hatch KF, Blanchard DK, Hatch GR, Wertheimer-Hatch L, Davis GB, Foster RJ, Skandalakis JE. Tumors of the rectum and anal canal. World J Surg 2000; 24: 437–43.PubMedCrossRefGoogle Scholar
- 20.Suster S. Gastrointestinal stromal tumors. Semin Diagn Pathol 1996; 13: 297–313.PubMedGoogle Scholar
- 21.Taniguchi M, Nishida T, Hirota S, Isozaki K, Ito T, Nomura T, Matsuda H, Kitamura Y. Effect of c-kit mutation on prognosis of gastrointestinal stromal tumors. Cancer Res 1999; 59: 4297–300.PubMedGoogle Scholar
- 22.Tworek JA, Goldblum JR, Weiss SW, Greenson JK, Appelman HD. Stromal tumors of the anorectum: a clinicopathologic study of 22 cases. Am J Surg Pathol 1999; 23: 946–54.PubMedCrossRefGoogle Scholar
- 23.Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006; 130: 1466–78.PubMedGoogle Scholar
- 24.Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000; 7: 705–12.PubMedCrossRefGoogle Scholar
- 25.Hassan I, You YN, Shyyan R, Dozois EJ, Smyrk TC, Okuno SH, Schleck CD, Hodge DO, Donohue JH. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol 2008; 15: 52–9.PubMedCrossRefGoogle Scholar
- 26.Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, Blackstein ME, Blanke CD, von Mehren M, Brennan MF, Patel S, McCarter MD, Polikoff JA, Tan BR, Owzar K. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009; 373: 1097–104.PubMedCrossRefGoogle Scholar
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