Abstract
Background
The small intestine, after the stomach, is the second most common primary site for gastrointestinal stromal tumors (GISTs). This study aimed to identify clinicopathologic prognostic factors of tumor recurrence and survival and to analyze the influence of imatinib and sunitinib for small-intestine GISTs.
Methods
We reviewed the surgical experience of patients with small-intestine GISTs at National Taiwan University Hospital from January 1995 to March 2007. We analyzed the perioperative clinicopathologic data and treatment course.
Results
Seventy patients were included. The tumor was local in 43 patients, advanced in 21 patients, and 6 had metastasis. The median size of the tumor was 6.5 cm. Forty-four patients had a mitotic rate of less than 5/50 high-power field. The 1-year and 5-year disease-free survival rates were 85 and 66.7%, respectively, while the 1-year and 5-year overall survival rates were 98.5 and 86.6%, respectively. There were 19 patients with recurrent disease and 6 patients died of intestinal GISTs. The response rate of imatinib and sunitinib were 73.3 and 60%, respectively. According to multivariate analysis for disease recurrence, only invasion status, tumor size, and mitotic rate are significant (P = 0.007, 0.035, 0.007 respectively). They are also associated with poor survival (P ≤ 0.001, 0.006, 0.002, respectively).
Conclusions
The invasion status, size, and mitotic rate of tumor involve higher risk of recurrence and poor survival in small-intestine GISTs. The patients with recurrent small-intestine GISTs may have a lower mortality rate after using imatinib and sunitinib.
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References
Mazur MT, Clark HB (1983) Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol 7:507–519
Kindblom LG, Remotti HE, Aldenborg F et al (1998) Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 152:1259–1269
Hirota S, Isozaki K, Moriyama Y et al (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577–580
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
Miettinen M, Makhlouf HR, Sobin LH et al (2006) Gastrointestinal stromal tumors (GISTs) of the jejunum and ileum: a clinicopathologic, immunohistochemical and molecular genetic study of 906 cases prior to imatinib with long-term follow-up. Am J Surg Pathol 30:477–489
Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465
Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472–480
Dagher R, Cohen M, Williams G et al (2002) Approval summary: imitanib mesylate in the treatment of metastatic and/or unresectable malignant gastrointestinal stromal tumors. Clin Cancer Res 8:3034–3038
Demetri GD, van Oosterom AT, Garrett CR et al (2006) Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomized controlled trial. Lancet 368:1329–1338
U.S. Food and Drug Administration. FDA approves new treatment for gastrointestinal and kidney cancer, P06-11. Available at http://www.fda.gov/bbs/topics/news/2006/NEW01302.html. Accessed 26 Jan 2006
Brainard JA, Goldblum JR (1997) Stromal tumors of the jejunum and ileum: a clinicopathologic study of 39 cases. Am J Surg Pathol 21:407–416
Ma CK, De Peralta MN, Amin MB et al (1997) Small intestinal stromal tumors: a clinicopathologic study of 20 cases with immunohistochemical assessment of cell differentiation and the prognostic role of proliferation antigens. Am J Clin Pathol 108:641–651
Crosby JA, Catton CN, Davis A et al (2001) Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol 8:50–59
Winfield RD, Hochwald SN, Vogel SB et al (2006) Presentation and management of gastrointestinal stromal tumors of the duodenum. Am Surg 72:719–723
Chiu YC, Lin JW, Changchien CS et al (2005) Clinicopathological characteristics and prognosis of patients with small intestinal stromal tumors. J Formosa Med Assoc 104:905–912
Tworek JA, Appelman HD, Singleton T et al (1997) Stromal tumors of the jejunum and ileum. Mod Pathol 10:200–209
Wu TJ, Lee LY, Yeh CN et al (2006) Surgical treatment and prognostic analysis for gastrointestinal stromal tumors (GISTs) of the small intestine: before the era of imatinib mesylate. BMC Gastroenterol 6:29
Lai IR, Chen CN, Lin MT et al (2008) Surgical treatment of gastric gastrointestinal stromal tumors: analysis of 92 operated patients. Dig Surg 25:208–212
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Huang, CC., Yang, CY., Lai, IR. et al. Gastrointestinal Stromal Tumor of the Small Intestine: A Clinicopathologic Study of 70 Cases in the Postimatinib Era. World J Surg 33, 828–834 (2009). https://doi.org/10.1007/s00268-009-9918-4
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DOI: https://doi.org/10.1007/s00268-009-9918-4