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

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

Till present, there are still controversies over the epidemiology, pathological features, types of surgical treatment, and prognoses of primary small gastric GISTs (gGISTs).

Methods

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.

Results

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.

Conclusion

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.

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Funding

This study is supported by Natural Science Foundation of Guangdong Province (2016A030310328).

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Author notes

  1. Zifeng Yang, Xingyu Feng, and Peng Zhang have an equal contribution to this article.

Authors and Affiliations

  1. Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China

    Zifeng Yang, Xingyu Feng & Yong Li

  2. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China

    Peng Zhang & Kai Xiong Tao

  3. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China

    Tao Chen & Guoxin Li

  4. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China

    Haibo Qiu & Zhiwei Zhou

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  1. Zifeng Yang
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China Gastrointestinal Stromal Tumor Study Group (CN-GIST)

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.

Corresponding authors

Correspondence to Kai Xiong Tao or Yong Li.

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Disclosure

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.

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Yang, Z., Feng, X., Zhang, P. et al. Clinicopathological features and prognosis of 276 cases of primary small (≤ 2 cm) gastric gastrointestinal stromal tumors: a multicenter data review. Surg Endosc 33, 2982–2990 (2019). https://doi.org/10.1007/s00464-018-6564-7

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  • DOI: https://doi.org/10.1007/s00464-018-6564-7

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