Annals of Surgical Oncology

, Volume 14, Issue 7, pp 2018–2027 | Cite as

Risk Criteria and Prognostic Factors for Predicting Recurrences After Resection of Primary Gastrointestinal Stromal Tumor

  • Piotr RutkowskiEmail author
  • Zbigniew I. Nowecki
  • Wanda Michej
  • Maria Dębiec-Rychter
  • Agnieszka Woźniak
  • Janusz Limon
  • Janusz Siedlecki
  • Urszula Grzesiakowska
  • Michał Kąkol
  • Czesław Osuch
  • Marcin Polkowski
  • Stanisław Głuszek
  • Zbigniew Żurawski
  • Włodzimierz Ruka
Gastrointestinal Oncology



The introduction of adjuvant imatinib in gastrointestinal stromal tumors (GISTs) raised debate over the accuracy of National Institutes of Health risk criteria and the significance of other prognostic factors in GIST.


Tumor aggressiveness and other clinicopathological factors influencing disease-free survival (DFS) were assessed in 335 patients with primary resectable CD117-immunopositive GISTs (median follow-up, 31 months after primary tumor resection) from a prospectively collected tumor registry.


Overall median DFS was 37 months, and estimated 5-year DFS was 37.8 %. In univariate analysis, high or intermediate risk group (P < .000001), mitotic index >5/50 high-power field (P < .00001), primary tumor size >5 cm (P < .00001), nongastric primary location (P = .0001), male sex (P = .01), R1 resection/tumor rupture (P = .0003), and epithelioid cell or mixed cell pathological subtype (P = .05) negatively affected DFS. In multivariate analysis, statistically significant factors negatively influencing DFS for model 1 were mitotic index >5/50 high-power field (P = .004), primary tumor size >5 cm (P = .001), male sex (P = .003), R1 resection/tumor rupture (P = .04), and nongastric primary tumor location (P = .02), and for model 2 were high/intermediate risk primary tumor (P < .0001 and P = .008, respectively), male sex (P = .007), resection R1/tumor rupture (P = .01), and nongastric primary tumor location (P = .02). Five-year DFS for high, intermediate, and low/very low risk group was 20%, 54%, and 96%, respectively.


The risk criteria for assessing the natural course of primary GISTs were validated, but additional independent prognostic factors—primary tumor location and sex—were also identified.


Gastrointestinal stromal tumor Surgery Prognosis 



Supported by the Polish State Committee for Scientific Research, grant 3P05C05925. We thank all doctors devoted to GIST treatment and diagnosis who collaborated in the Polish Clinical GIST Registry, M. Rosinska for statistical advice, and J. Lasota (Armed Forces Institute of Pathology, Washington, DC) for critical remarks and mutational analyses data.


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Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Piotr Rutkowski
    • 1
    Email author
  • Zbigniew I. Nowecki
    • 1
  • Wanda Michej
    • 2
  • Maria Dębiec-Rychter
    • 3
  • Agnieszka Woźniak
    • 4
  • Janusz Limon
    • 4
  • Janusz Siedlecki
    • 5
  • Urszula Grzesiakowska
    • 6
  • Michał Kąkol
    • 7
  • Czesław Osuch
    • 8
  • Marcin Polkowski
    • 9
  • Stanisław Głuszek
    • 10
  • Zbigniew Żurawski
    • 1
  • Włodzimierz Ruka
    • 1
  1. 1.Department of Soft Tissue/Bone Sarcoma and MelanomaM. Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  2. 2.Department of PathologyM. Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  3. 3.Center for Human GeneticsUniversity of LeuvenLeuvenBelgium
  4. 4.Department of Biology and GeneticsMedical University of GdanskGdanskPoland
  5. 5.Department of Molecular BiologyM. Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  6. 6.Department of RadiologyM. Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  7. 7.Regional Oncological CenterGdanskPoland
  8. 8.Department of General SurgeryJagiellonian UniversityCracowPoland
  9. 9.Department of GastroenterologyM. Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  10. 10.City HospitalKielcePoland

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