Advertisement

Indian Journal of Gastroenterology

, Volume 32, Issue 1, pp 22–27 | Cite as

Clinicopathological study of 113 gastrointestinal stromal tumors

  • Rahul Bhalgami
  • Kak Manish
  • Prachi Patil
  • Shaesta Mehta
  • K. M. Mohandas
Original Article

Abstract

Background

Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the gastrointestinal tract. A retrospective study was done to evaluate the clinical and pathological features and the effect of adjuvant treatment with imatinib.

Method

The case records of 113 GIST patients were retrospectively reviewed and the clinicopathological features, treatments, and outcomes were recorded.

Results

There were 82 males and 31 females, with a median age of 51 years. All patients were symptomatic (mean duration 4 months) and abdominal pain was the most common symptom. The primary sites of GIST were small intestine (38), stomach (36), and others (39). The tumor diameter on imaging varied from 1 to 26 (mean 10.9) cm. Thirty percent of patients presented with metastasis. There was no association between tumor size and presence of metastasis (p = 0.9). Most common histology was spindle cell morphology followed by mixed spindle cell and epithelioid morphology. Seventy percent patients had high risk (HR) category as per Fletcher risk score. Fifty-three percent had curative resection, after which 34 % had adjuvant imatinib therapy. Recurrence rates were significantly lower in patients receiving adjuvant imatinib therapy (p = 0.003). No statistically significant association was noted between HR Fletcher score, Mib score >10, tumor size >10 cm, and the risk of recurrence (p = 0.29, 0.07, and 0.87, respectively). Liver was the most common site of metastasis. Side effects were tolerable and edema and fluid retention were the commonest.

Conclusion

Sites of GIST in Indian patients were different from those in western studies. Adjuvant imatinib therapy significantly reduced the risk of recurrence.

Keywords

GIST Imatinib Mib index 

Notes

Acknowledgments

We are thankful to Dr. Mukta Ramadwar for her valuable help and advice in this study.

Conflict of interest

None

References

  1. 1.
    Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors [GISTs]: a review. Eur J Cancer. 2002;38 Suppl 5:S39–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Solis-Herruzo JA, Solis-Muñoz P. GISTs: from the molecular knowledge to the rational treatment. Rev Esp Enferm Dig. 2003;95:677–82.PubMedGoogle Scholar
  3. 3.
    Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Nilsson B, Bumming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-base study in western Sweden. Cancer. 2005;103:821–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Goettsch WG, Bos SD, Breekveldt-Postma N, et al. Incidence of gastrointestinal stromal tumors is underestimated: results of a nation-wide study. Eur J Cancer. 2005;41:2868–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Sircar K, Hewlett BR, Huizinga JD, et al. Interstitial cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol. 1999;23:377–89.PubMedCrossRefGoogle Scholar
  7. 7.
    Sanders KM. A case of interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract. Gastroenterology. 1996;111:492–515.PubMedCrossRefGoogle Scholar
  8. 8.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.PubMedCrossRefGoogle Scholar
  9. 9.
    Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Bucher P, Villiger P, Egger J, et al. Management of gastrointestinal stromal tumors: from diagnosis to treatment. Swiss Med Wkly. 2004;134:145–53.PubMedGoogle Scholar
  11. 11.
    Rajappa S, Muppavarapu KM, Uppin S, Digumarti R. Gastrointestinal stromal tumors: a single institution experience of 50 cases. Indian J Gastroenterol. 2007;26:225–9.PubMedGoogle Scholar
  12. 12.
    Roberts P, Eisenberg B. Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer. 2002;38:S37–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Connolly E, Gaffney E, Reynolds J. Gastrointestinal stromal tumors. Br J Surg. 2003;90:1178–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Dematteo RP, Heinrich MC, El-Rifai WM, et al. Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol. 2002;33:466–77.PubMedCrossRefGoogle Scholar
  15. 15.
    Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347:472–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Joensuu H, Fletcher C, Dimitrijevic S, et al. Management of malignant gastrointestinal stromal tumors. Lancet Oncol. 2002;3:655–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Verweij J, Casali P, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumors with high-dose imatinib: randomized trial. Lancet. 2004;364:1127–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Rubin BP, Singer S, Tsao C, et al. KIT activation is an ubiquitous feature of gastrointestinal stromal tumors. Cancer Res. 2001;61:8118–21.PubMedGoogle Scholar
  19. 19.
    Dematteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumor: a randomized, double blind, placebo controlled trial. Lancet. 2009;373:1097–104.PubMedCrossRefGoogle Scholar
  20. 20.
    Vij M, Agrawal V, Kumar A, Pandey R. Gastrointestinal stromal tumors: a clinicopathological and immunohistochemical study of 121 cases. Indian J Gastroenterol. 2010;29:231–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Singh A, Chatterjee P, Pai MC, Chacko RT. Gastrointestinal stromal tumours: a clinico-radiologic review from a single centre in South India. J Med Imaging Radiat Oncol. 2009;53:522–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Terada T. Gastrointestinal stromal tumor of the digestive organs: a histopathologic study of 31 cases in a single Japanese institute. Int J Clin Exp Pathol. 2009;3:162–8.PubMedGoogle Scholar
  24. 24.
    Cho MY, Sohn JH, Kim JM, et al. Current trends in the epidemiological and pathological characteristics of gastrointestinal stromal tumors in Korea, 2003–2004. J Korean Med Sci. 2010;25:853–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T. Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer. 2003;6:39–48.PubMedCrossRefGoogle Scholar
  26. 26.
    Demetri GD, von Mehren M, Antonescu CR, et al. NCCN task force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010;8 Suppl 2:S1–41.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2012

Authors and Affiliations

  • Rahul Bhalgami
    • 1
    • 2
  • Kak Manish
    • 1
  • Prachi Patil
    • 1
  • Shaesta Mehta
    • 1
  • K. M. Mohandas
    • 1
  1. 1.Tata Memorial HospitalMumbaiIndia
  2. 2.GandhinagarIndia

Personalised recommendations