Clinicopathological features and prognostic factors of gastric intermediate-risk gastrointestinal stromal tumor after surgical resection: a retrospective study.
10.3760/cma.j.cn112151-20220623-00548
- VernacularTitle:外科手术切除胃中危胃肠间质瘤临床病理特征和预后因素的回顾性研究
- Author:
Wei YUAN
1
;
Wen HUANG
1
;
Lei REN
1
;
Huai Yu LIANG
1
;
Xiang Yang DU
1
;
Min FU
2
;
Chen XU
1
;
Yong FANG
2
;
Kun Tang SHEN
2
;
Ying Yong HOU
1
Author Information
1. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
2. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
- Publication Type:Journal Article
- MeSH:
Male;
Female;
Humans;
Middle Aged;
Gastrointestinal Stromal Tumors/surgery*;
Retrospective Studies;
Antineoplastic Agents/therapeutic use*;
Prognosis;
Imatinib Mesylate/therapeutic use*;
Mutation;
Proto-Oncogene Proteins c-kit/genetics*
- From:
Chinese Journal of Pathology
2023;52(4):384-389
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the clinicopathological features, treatment and prognosis of gastric intermediate-risk gastrointestinal stromal tumor (GIST), so as to provide a reference for clinical management and further research. Methods: A retrospective observational study of patients with gastric intermediate-risk GIST, who underwent surgical resection between January 1996 and December 2019 at Zhongshan Hospital of Fudan University, was carried out. Results: Totally, 360 patients with a median age of 59 years were included. There were 190 males and 170 females with median tumor diameter of 5.9 cm. Routine genetic testing was performed in 247 cases (68.6%, 247/360), and 198 cases (80.2%) showed KIT mutation, 26 cases (10.5%) showed PDGFRA mutation, and 23 cases were wild-type GIST. According to "Zhongshan Method"(including 12 parameters), there were 121 malignant and 239 non-malignant cases. Complete follow-up data were available in 241 patients; 55 patients (22.8%) received imatinib therapy, 10 patients (4.1%) experienced tumor progression, and one patient (PDGFRA mutation, 0.4%) died. Disease-free survival (DFS) and overall survival rate at 5 years was 96.0% and 99.6%, respectively. Among the intermediate-risk GIST, there was no difference in DFS between the overall population, KIT mutation, PDGFRA mutation, wild-type, non-malignant and malignant subgroups (all P>0.05). However, the non-malignancy/malignancy analysis showed that there were significant differences in DFS among the overall population (P<0.01), imatinib treatment group (P=0.044) and no imatinib treatment group (P<0.01). Adjuvant imatinib resulted in potential survival benefit for KIT mutated malignant and intermediate-risk GIST in DFS (P=0.241). Conclusions: Gastric intermediate-risk GIST shows a heterogeneous biologic behavior spectrum from benign to highly malignant. It can be further classified into benign and malignant, mainly nonmalignant and low-grade malignant. The overall disease progression rate after surgical resection is low, and real-world data show that there is no significant benefit from imatinib treatment after surgery. However, adjuvant imatinib potentially improves DFS of intermediate-risk patients with tumors harboring KIT mutation in the malignant group. Therefore, a comprehensive analysis of gene mutations in benign/malignant GIST will facilitate improvements in therapeutic decision-making.
