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Additional malignancies in patients with gastrointestinal stromal tumors (GIST): incidence, pathology and prognosis according to a time of occurrence-based classification

  • J. A. FernándezEmail author
  • V. Olivares
  • A. J. Gómez-Ruiz
  • B. Ferri
  • M. D. Frutos
  • T. Soria
  • G. Torres
  • P. Parrilla
Research Article

Abstract

Background

The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients.

Methods

We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification.

Results

Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST.

Conclusions

The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.

Keywords

Gastrointestinal stromal tumor GIST Multiple neoplasms Associated neoplasms Classification 

Notes

Acknowledgements

The authors acknowledge the work of Galian MJ for her technical assistance in the preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors have any financial disclosures to make regarding the eventual acceptance and publication of this study.

Ethical approval

This work has been approved by the ethics committee of the hospital.

Informed consent

The included patients have been informed and have consented to the use of their data anonymously for their scientific use.

References

  1. 1.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438(1):1–12.CrossRefGoogle Scholar
  2. 2.
    Miettinen M, Fetsch JF, Sobin LH, Lasota J. Gastrointestinal stromal tumors in patients with neurofibromatosis 1: a clinicopathologic and molecular genetic study of 45 cases. Am J Surg Pathol. 2006;30(1):90.CrossRefGoogle Scholar
  3. 3.
    Carney JA. The triad of gastric epithelioid leiomyosarcoma, pulmonary chondroma, and functioning extra-adrenal paraganglioma: a five-year review. Medicine (Baltimore). 1983;62(3):159–69.CrossRefGoogle Scholar
  4. 4.
    Maeyama H, Hidaka E, Ota H, et al. Familial gastrointestinal stromal tumor with hyperpigmentation: association with a germline mutation of the c-kit gene. Gastroenterology. 2001;120(1):210–5.CrossRefGoogle Scholar
  5. 5.
    Burgoyne AM, Somaiah N, Sicklick JK. Gastrointestinal stromal tumors in the setting of multiple tumor syndromes. Curr Opin Oncol. 2014;26(4):408.CrossRefGoogle Scholar
  6. 6.
    Giuliani J, Bonetti A. The occurrence of gastrointestinal stromal tumors and second malignancies. J Gastrointest Canc. 2015;46(4):408–12.CrossRefGoogle Scholar
  7. 7.
    Agaimy A, Wünsch PH, Sobin LH, et al. Occurrence of other malignancies in patients with gastrointestinal stromal tumors. Semin Diagn Pathol. 2006;23(2):120–9.CrossRefGoogle Scholar
  8. 8.
    Fernández Hernández JÁ, Olivares Ripoll V, Parrilla Paricio P. Asociación de tumores del estroma gastrointestinal con otros tumores primarios. Propuesta de una nueva clasificación. Med Clín. 2016;147(9):405–9.CrossRefGoogle Scholar
  9. 9.
    Warren S. Multiple primary malignant tumors A survey of the literature and a statistical study. Am J Cancer. 1932;16:1358–414.Google Scholar
  10. 10.
    Feinstein AR, Bondy PK. A new staging system for cancer, and a re-appraisal of “early” treatment and “cure” by radical surgery. Trans Assoc Am Phys. 1967;80:111–22.PubMedGoogle Scholar
  11. 11.
    Sellers AH. The clinical classification of malignant tumours: the TNM system. Can Med Assoc J. 1971;105(8):836.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Cananzi FCM, Judson I, Lorenzi B, et al. Multidisciplinary care of gastrointestinal stromal tumour: a review and a proposal for a pre-treatment classification. Eur J Surg Oncol. 2013;39(11):1171–8.CrossRefGoogle Scholar
  13. 13.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70–83.CrossRefGoogle Scholar
  14. 14.
    Kramer K, Wolf S, Mayer B, et al. Frequence, spectrum and prognostic impact of additional malignancies in patients with gastrointestinal stromal tumors. Neoplasia. 2015;17(1):134–40.CrossRefGoogle Scholar
  15. 15.
    Rodriquenz MG, Rossi S, Ricci R, et al. Gastrointestinal stromal tumors (GISTs) and second malignancies. Medicine (Baltimore) [Internet]. 2016 Sep 23 [cited 2018 May 29];95(38). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044889/.
  16. 16.
    Vassos N, Agaimy A, Hohenberger W, Croner RS. Coexistence of gastrointestinal stromal tumours (GIST) and malignant neoplasms of different origin: prognostic implications. Int J Surg. 2014;12(5):371–7.CrossRefGoogle Scholar
  17. 17.
    Sevinc A, Seker M, Bilici A, et al. Co-existence of gastrointestinal stromal tumors with other primary neoplasms. Hepatogastroenterology. 2011;58(107–108):824–30.PubMedGoogle Scholar
  18. 18.
    Yan Y, Li Z, Liu Y, Zhang L, Li J, Ji J. Coexistence of gastrointestinal stromal tumors and gastric adenocarcinomas. Tumor Biol. 2013;34(2):919–27.CrossRefGoogle Scholar
  19. 19.
    Adim SB, Filiz G, Kanat O, Yerci O. Simultaneous occurrence of synchronous and metachronous tumors with gastrointestinal stromal tumors. Bratisl Lek Listy. 2011;112(11):623–5.PubMedGoogle Scholar
  20. 20.
    Gonçalves R, Linhares E, Albagli R, et al. Occurrence of other tumors in patients with GIST. Surg Oncol. 2010;19(4):e140–3.CrossRefGoogle Scholar
  21. 21.
    Pandurengan RK, Dumont AG, Araujo DM, et al. Survival of patients with multiple primary malignancies: a study of 783 patients with gastrointestinal stromal tumor. Ann Oncol. 2010;21(10):2107–11.CrossRefGoogle Scholar
  22. 22.
    Murphy JD, Ma GL, Baumgartner JM, Madlensky L, Burgoyne AM, Tang C-M, et al. Increased risk of additional cancers among patients with gastrointestinal stromal tumors: a population-based study. Cancer. 2015;121(17):2960–7.CrossRefGoogle Scholar
  23. 23.
    Hechtman JF, DeMatteo R, Nafa K, et al. Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST): a clinicopathologic study of 260 patients with molecular analysis and review of the literature. Ann Surg Oncol. 2015;22(8):2633–9.CrossRefGoogle Scholar
  24. 24.
    Smith MJ, Smith HG, Mahar AL, et al. The impact of additional malignancies in patients diagnosed with gastrointestinal stromal tumors. Int J Cancer. 2016;139(8):1744–51.CrossRefGoogle Scholar
  25. 25.
    Du J, Shen N, He H-S, et al. Synchronous gastrointestinal cancer and gastrointestinal stromal tumors: a single-institution experience. World J Surg Oncol. 2016;14(1):130.CrossRefGoogle Scholar
  26. 26.
    Karanikas M, Machairiotis N, Zarogoulidis P, et al. Non-Hodgkin lymphoma and GIST: molecular pathways and clinical expressions. Onco Targets Ther. 2012;12(5):433–8.Google Scholar
  27. 27.
    Zhou Y, Wu X-D, Shi Q, Jia J. Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas. World J Gastroenterol. 2013;19(12):2005–8.CrossRefGoogle Scholar
  28. 28.
    Lin M, Lin J-X, Huang C-M, et al. Prognostic analysis of gastric gastrointestinal stromal tumor with synchronous gastric cancer. World J Surg Oncol. 2014;12(1):25.CrossRefGoogle Scholar
  29. 29.
    Phan K, Martires K, Kurlander DE, et al. The incidence of second primary malignancies after gastrointestinal stromal tumor before and after the introduction of imatinib mesylate. Trans Cancer Res. 2013;3(2):152–9.Google Scholar
  30. 30.
    Liszka Ł, Zielińska-Pająk E, Pająk J, et al. Coexistence of gastrointestinal stromal tumors with other neoplasms. J Gastroenterol. 2007;42(8):641–9.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Servicio de Cirugía General y del Aparato DigestivoHospital Clínico Universitario “Virgen de la Arrixaca”MurciaSpain
  2. 2.Servicio de Anatomía PatológicaHospital Clínico Universitario “Virgen de la Arrixaca”MurciaSpain

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