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Predictors of lymph node metastasis in patients with gastrointestinal stromal tumors (GISTs)

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Abstract

Background

Lymph node metastasis is not common among patients with gastrointestinal stromal tumors (GISTs) and its prognostic value is controversial. The purposes of this study are to identify predictors of lymph node metastasis and determine its prognostic associations.

Methods

A retrospective analysis of the surveillance, epidemiology and end results (SEER) database was performed. Patients with GISTs that underwent surgery and pathologic nodal staging were identified. Logistic regression and Cox regression were performed to identify independent predictors and prognostic factors, respectively.

Results

Of 1430 patients (age: 61.5 ± 14.5 years, 52% males), 140 (9.8%) had lymph node metastasis. On multivariable analysis, distant metastasis was the only independent predictor of lymph node metastasis (OR 4.95, 95% CI: 2.43–10.08, p < 0.001). In the entire cohort, lymph node metastasis did not reflect a worse overall survival (OS, HR 1.12, 95% CI: 0.49–2.58, p = 0.794) or disease-specific survival (DSS, HR 0.95, 95% CI: 0.31–2.88, p = 0.924), but was an independent predictor of worse OS in 51 patients (25.4% of 201 patients) who presented with both lymph node metastasis and synchronous distant metastasis (HR 2, 95% CI: 1.25–3.21, p = 0.004). Lymph node metastasis was also independently associated with worse survival among patients with small intestinal (OS: HR 1.88, 95% CI: 1.15–3.1, p = 0.013) and colorectal tumors (OS: HR 3.41, 95% CI: 1.56–7.46, p = 0.002, DSS: HR 3.58, 95% CI: 1.27–10.06, p = 0.016).

Conclusions

Metastatic disease is an independent predictor of lymph node metastasis in patients with GISTs. Lymph node metastasis is also associated with worse overall survival in patients with metastatic GISTs.

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References

  1. Ma GL, Murphy JD, Martinez ME, Sicklick JK (2015) Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study. Cancer Epidemiol Biomark Prev 24:298–302. https://doi.org/10.1158/1055-9965.EPI-14-1002

    Article  Google Scholar 

  2. Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG (2005) Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era. Cancer 103:821–829. https://doi.org/10.1002/cncr.20862

    Article  PubMed  Google Scholar 

  3. Fletcher CDM, 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 (2002) Diagnosis of gastrointestinal stromal tumors:a consensus approach. Int J Surg Pathol 10:81–89. https://doi.org/10.1177/106689690201000201

    Article  PubMed  Google Scholar 

  4. Lasota J, Miettinen M (2006) KIT and PDGFRA mutations in gastrointestinal stromal tumors (GISTs). Semin Diagn Pathol 23:91–102

    Article  PubMed  Google Scholar 

  5. Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23:70–83

    Article  PubMed  Google Scholar 

  6. Tran T, Davila JA, El-Serag HB (2005) The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 100:162–168. https://doi.org/10.1111/j.1572-0241.2005.40709.x

    Article  PubMed  Google Scholar 

  7. von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Conrad EU III, Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM III, 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 14:758–786

    Article  Google Scholar 

  8. Tokunaga M, Ohyama S, Hiki N, et al. Incidence and prognostic value of lymph node metastasis on c-Kit-positive gastrointestinal stromal tumors of the stomach. Hepatogastroenterology. 58:1224–8

  9. Gong N, Wong CS, Chu YC (2011) Is lymph node metastasis a common feature of gastrointestinal stromal tumor? Clin Nucl Med 36:678–682. https://doi.org/10.1097/RLU.0b013e318219ad31

    Article  PubMed  Google Scholar 

  10. Rubin BP (2006) Gastrointestinal stromal tumours: an update. Histopathology 48:83–96. https://doi.org/10.1111/j.1365-2559.2005.02291.x

    Article  PubMed  CAS  Google Scholar 

  11. Güller U, Tarantino I, Cerny T, Schmied BM, Warschkow R (2015) Population-based SEER trend analysis of overall and cancer-specific survival in 5138 patients with gastrointestinal stromal tumor. BMC Cancer 15:557. https://doi.org/10.1186/s12885-015-1554-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Liu W, Zeng X, Wu X, He J, Gao J, Shuai X, Wang G, Zhang P, Tao K (2017) Clinicopathologic study of succinate-dehydrogenase-deficient gastrointestinal stromal tumors. Medicine (Baltimore) 96:e7668. https://doi.org/10.1097/MD.0000000000007668

    Article  Google Scholar 

  13. Miettinen M, Wang Z-F, Sarlomo-Rikala M, Osuch C, Rutkowski P, Lasota J (2011) Succinate dehydrogenase-deficient GISTs. Am J Surg Pathol 35:1712–1721. https://doi.org/10.1097/PAS.0b013e3182260752

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mason EF, Hornick JL (2016) Conventional risk stratification fails to predict progression of succinate dehydrogenase–deficient gastrointestinal stromal tumors. Am J Surg Pathol 40:1616–1621. https://doi.org/10.1097/PAS.0000000000000685

    Article  PubMed  Google Scholar 

  15. Boikos SA, Pappo AS, Killian JK, LaQuaglia MP, Weldon CB, George S, Trent JC, von Mehren M, Wright JA, Schiffman JD, Raygada M, Pacak K, Meltzer PS, Miettinen MM, Stratakis C, Janeway KA, Helman LJ (2016) Molecular subtypes of KIT/PDGFRA wild-type gastrointestinal stromal tumors. JAMA Oncol 2:922–928. https://doi.org/10.1001/jamaoncol.2016.0256

    Article  PubMed  PubMed Central  Google Scholar 

  16. Prakash S, Sarran L, Socci N, DeMatteo RP, Eisenstat J, Greco AM, Maki RG, Wexler LH, LaQuaglia MP, Besmer P, Antonescu CR (2005) Gastrointestinal stromal tumors in children and young adults: a clinicopathologic, molecular, and genomic study of 15 cases and review of the literature. J Pediatr Hematol Oncol 27:179–187

    Article  PubMed  Google Scholar 

  17. Agaimy A, Wünsch PH (2009) Lymph node metastasis in gastrointestinal stromal tumours (GIST) occurs preferentially in young patients ≤40 years: an overview based on our case material and the literature. Langenbeck's Arch Surg 394:375–381. https://doi.org/10.1007/s00423-008-0449-5

    Article  Google Scholar 

  18. National Cancer Institute (2013) Overview of the SEER Program

  19. DeMatteo RP, Lewis JJ, Leung D et al (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Zhang L, Smyrk TC, Young WF et al (2010) Gastric stromal tumors in Carney triad are different clinically, pathologically, and behaviorally from sporadic gastric gastrointestinal stromal tumors: findings in 104 cases. Am J Surg Pathol 34:53–64. https://doi.org/10.1097/PAS.0b013e3181c20f4f

    Article  PubMed  PubMed Central  Google Scholar 

  21. Miettinen M, Lasota J, Sobin LH (2005) Gastrointestinal stromal tumors of the stomach in children and young adults: a clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases with long-term follow-up and review of the literature. Am J Surg Pathol 29:1373–1381

    Article  PubMed  Google Scholar 

  22. Valadão M, de Mello ELR, Lourenço L, et al. What is the prognostic significance of metastatic lymph nodes in GIST? Hepatogastroenterology. 55:471–4

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Funding

This study was supported by the General Secretariat for Research and Technology (GSRT) and the Hellenic Foundation for Research and Innovation (HFRI) (grant number 837).

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Authors and Affiliations

  1. Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece

    Apostolos Gaitanidis, Alexandra Tsaroucha & Michail Pitiakoudis

  2. Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Mustapha El Lakis

  3. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Michail Alevizakos

Authors
  1. Apostolos Gaitanidis
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  2. Mustapha El Lakis
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  3. Michail Alevizakos
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  4. Alexandra Tsaroucha
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  5. Michail Pitiakoudis
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Contributions

Study concept and design: Gaitanidis, Pitiakoudis. Data acquisition, analysis, and interpretation: all authors. Drafting of the manuscript: Gaitanidis, El Lakis, Alevizakos. Critical revision of the manuscript: all authors. Final approval of the manuscript: all authors. Study supervision: Pitiakoudis.

Corresponding author

Correspondence to Apostolos Gaitanidis.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No formal consent was required for this study, due to the use of a large cancer database with unidentifiable patient information.

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Gaitanidis, A., El Lakis, M., Alevizakos, M. et al. Predictors of lymph node metastasis in patients with gastrointestinal stromal tumors (GISTs). Langenbecks Arch Surg 403, 599–606 (2018). https://doi.org/10.1007/s00423-018-1683-0

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  • DOI: https://doi.org/10.1007/s00423-018-1683-0

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