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Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs

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Abstract

Background

Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib.

Methods

We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed.

Results

JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05).

Conclusions

The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.

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Abbreviations

GIST:

Gastrointestinal stromal tumour

JI-GIST:

Gastrointestinal stromal tumours located in the jejunum or ileum

G-GIST:

Gastrointestinal stromal tumours with gastric location

UGB:

Upper gastrointestinal bleeding

KIT:

Gene located on chromosome 4q12

PDGFRA:

Platelet derived growth factor receptor alpha

HPF:

High-power field

NIH:

National Institutes of Health

AFIP:

Armed forces institute of pathology

DFS:

Disease-free survival

OS:

Overall survival

MSKCCn:

Memorial Sloan Kettering Cancer Center nomogram

NS:

Not statistically significant

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Authors and Affiliations

  1. Digestive Surgery Department, Sarcoma Unit, “Virgen de La Arrixaca” University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain

    J. A. Fernández, D. Ferreras, J. J. Ruiz-Manzanera, V. Olivares & M. D. Frutos

  2. Pathology Department, “Virgen de La Arrixaca” University Hospital, Murcia, Spain

    B. Ferri

  3. Oncology Department, “Virgen de La Arrixaca” University Hospital, Murcia, Spain

    J. Martínez

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Contributions

All authors have contributed equally to the conception of the work, the acquisition, analysis, interpretation of data, drafting the work, and revising it critically for important intellectual content; final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to J. A. Fernández.

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All of the procedures carried out in studies with human participants were in accordance with the ethical standards of the institutional and/or national research committee and the Declaration of Helsinki of 1964 and its subsequent modifications or comparable ethical standards. The study was approved by the Ethics Committee of the “La Arrixaca” University Hospital in Murcia.

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Fernández, J.A., Ferreras, D., Ruiz-Manzanera, J.J. et al. Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs. Clin Transl Oncol 23, 1368–1376 (2021). https://doi.org/10.1007/s12094-020-02528-y

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