Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival.

By R. DeMatteo, J. Lewis, D. Leung, S. Mudan, J. Woodruff, M. Brennan. Annals of Surgery, 2000

2,766 citations recorded by the source corpus.

OBJECTIVE To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively. SUMMARY BACKGROUND DATA A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven. METHODS Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival. RESULTS Of the 200 patients, 46% had primary disease without metastasis, 47% had metastasis, and 7% had isolated local recurrence. In patients with primary disease who underwent complete resection of gross disease (n = 80), the 5-year actuarial survival rate was 54%, and survival was predicted by tumor size but not microscopic margins of resection. Recurrence of disease after resection was predominantly intraabdominal and involved the original tumor site, peritoneum, and liver. CONCLUSIONS GISTs are uncommon sarcomas. Tumor size predicts disease-specific survival in patients with primary disease who undergo complete gross resection. Tumor recurrence tends to be intraabdominal. Investigational protocols are indicated to reduce the rate of recurrence after resection and to improve the outcome for patients with GIST.

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Citations in the corpus

• Acquired Resistance to Imatinib in Gastrointestinal Stromal Tumor Occurs Through Secondary Gene Mutation (2005, background): “Their median duration of imatinib therapy was 8 (1-22) months.”
• Gastrointestinal Stromal Tumors of the Stomach: A Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 1765 Cases With Long-term Follow-up (2005, unknown): “Anterior wall (gastric body) 68 35:33 (51) 58 (19–85) 10-31-21-12 1-6-9-10 Epithelioid nonmalignant 43% 5/52 (10) 13/18 (72) 18/25 (72) 4/24 (17) 1/25 (4) 1/24 (4)”
• Risk stratification of patients diagnosed with gastrointestinal stromal tumor. (2008, background): “DeMatteo et al [15] Eighty patients after complete surgical resection; tumor location not specified for this patient subset Tumor size N10 cm predicted poorer 5-y DSS (RR, 2.”
• The Epidemiology of Malignant Gastrointestinal Stromal Tumors: An Analysis of 1,458 Cases from 1992 to 2000 (2005, background): “In some studies, GIST arising from the stomach was less aggressive than those affecting the lower gastrointestinal tract (26, 34) while other studies found no differences in survival (12, 19, 28).”
• Soft Tissue Sarcomas (2001, background): “for all patients with GISTs and up to 75% for patients with early-stage tumors that have been completely excised.(33,111) c-Kit expression has emerged as an important defining feature of GISTs, the pathogenesis of which may be related to c-Kit mutations, which are common in GISTs.”
• Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. (2002, background): “5 Despite the extensive metastatic disease in the majority of our patients, 88 percent were alive one year after the initiation of treatment with imatinib, with the median duration of survival not yet reached.”
• Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. (2005, background): “Whether complete remission achieved by surgery may cure advanced GIST patient is unknown (see below) [29, 30].”
• Gastrointestinal stromal tumors: The incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era (2005, unknown): “Clinical-incidental 60 (21) 24/36 74 (42–89) Gastric (23), duodenum (1), jejunum-ileum (32), colon (2), omentum (2) 2.”
• Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. (2016, background): “the disease [18–21], the epidemiology from population-based perspectives is less well described.”
• STI571 inactivation of the gastrointestinal stromal tumor c-KIT oncoprotein: biological and clinical implications (2001, background): “…patients presenting with localized GIST; however, many patients with localized GIST ultimately relapse, and unresectable and metastatic GIST has a poor prognosis because systemic chemotherapy and local radiotherapy are ine ective (Ueyama et al., 1992; Edmonson et al., 1999; DeMatteo et al., 2000).”