Skip to main content

Advertisement

SpringerLink
Log in

Long-term follow-up in 54 surgically treated patients with gastrointestinal stromal tumours

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the alimentary tract. Since these tumours are rather resistant to radiation and conventional chemotherapy, prognosis may be poor. Imatinib, a KIT tyrosine kinase inhibitor, has been shown to have dramatic antitumour effects on GISTs; however, surgical en bloc resection of the tumour with free resection margins remains still the first option for cure.

Materials and methods

Here, we present a retrospective study with 54 consecutive GIST patients who were treated surgically at our University Hospital between 1993 and 2005 and were followed up at 5 and 10 years.

Results

The disease-specific survival rate was 94% at 1 year, 91% at 3 years, 76% at 5 years, and 72% at 10 years. In univariate analysis, tumour size, mitotic rate, morphology, and necrosis predicted survival in patients with negative margins. Age, sex, and symptoms did not influence outcome.

Conclusion

GISTs have a high incidence of associated secondary malignancies which may have a significant influence on prognosis and outcome. Patients with R0 resections had a significantly better survival rate of 86% at 5 years and of 81% at 10 years than those with R1 and R2 resections (21% and 0%).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Miettinen M, Lasota J (2001) Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 438:1–12

    Article  PubMed  CAS  Google Scholar 

  2. Andtbacka RH, Ng CS, Scaife CL, Cormier JN, Hunt KK, Pisters PW, Pollock RE, Benjamin RS, Burgess MA, Chen LL, Trent J, Patel SR, Raymond K, Feig BW (2007) Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol 14:14–24

    Article  PubMed  Google Scholar 

  3. Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, Issels R, van Oosterom A, Hogendoorn PC, Van Glabbeke M, Bertulli R, Judson I (2004) Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 364:1127–1134

    Article  PubMed  CAS  Google Scholar 

  4. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri GD (2005) 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. Ann Oncol 16:566–578

    Article  PubMed  Google Scholar 

  5. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  PubMed  CAS  Google Scholar 

  6. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58

    Article  PubMed  CAS  Google Scholar 

  7. Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, Sobin LH, Lasota J (2003) Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 27:625–641

    Article  PubMed  Google Scholar 

  8. Agaimy A, Wunsch PH, Sobin LH, Lasota J, Miettinen M (2006) Occurrence of other malignancies in patients with gastrointestinal stromal tumors. Sem Diagn Pathol 23:120–129

    Article  Google Scholar 

  9. Rudolph P, Chiaravalli AM, Pauser U, Oschlies I, Hillemanns M, Gobbo M, Marichal M, Eusebi V, Hofler H, Capella C, Kloppel G (2002) Gastrointestinal mesenchymal tumors—immunophenotypic classification and survival analysis. Virchows Arch 441:238–248

    Article  PubMed  CAS  Google Scholar 

  10. An JY, Choi MG, Noh JH, Sohn TS, Kang WK, Park CK, Kim S (2007) Gastric GIST: A single institutional retrospective experience with surgical treatment for primary disease. Eur J Surg Oncol 33(8):1030–1035

    PubMed  CAS  Google Scholar 

  11. Bucher P, Egger JF, Gervaz P, Ris F, Weintraub D, Villiger P, Buhler LH, Morel P (2006) An audit of surgical management of gastrointestinal stromal tumours (GIST). Eur J Surg Oncol 32:310–314

    Article  PubMed  CAS  Google Scholar 

  12. Fujimoto Y, Nakanishi Y, Yoshimura K, Shimoda T (2003) Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: analysis of results in 140 surgically resected patients. Gastric Cancer 6:39–48

    Article  PubMed  Google Scholar 

  13. Langer C, Gunawan B, Schuler P, Huber W, Fuzesi L, Becker H (2003) Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg 90:332–339

    Article  PubMed  CAS  Google Scholar 

  14. Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ (2001) The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 136:383–389

    Article  PubMed  CAS  Google Scholar 

  15. Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumours. Br J Surg 90:1178–1186

    Article  PubMed  CAS  Google Scholar 

  16. Gold JS, Dematteo RP (2006) Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg 244:176–184

    Article  PubMed  Google Scholar 

  17. Gold JS, van der Zwan SM, Gonen M, Maki RG, Singer S, Brennan MF, Antonescu CR, De Matteo RP (2007) Outcome of metastatic GIST in the era before tyrosine kinase inhibitors. Ann Surg Oncol 14:134–142

    Article  PubMed  Google Scholar 

  18. Gupta M, Sheppard BC, Corless CL, MacDonell KR, Blanke CD, Billingsley KG (2006) Outcome following surgical therapy for gastrointestinal stromal tumors. J Gastrointest Surg 10:1099–1105

    Article  PubMed  Google Scholar 

  19. Verreet PR, Clausing TA, Schoepp C (2000) Prinzipien des chirurgischen Vorgehens beim Stromatumor. Chirurg 71:1335–1344

    Article  PubMed  CAS  Google Scholar 

  20. Maki RG (2004) Gastrointestinal stromal tumors respond to tyrosine kinase-targeted therapy. Curr Treat Options Gastroenterol 7:13–17

    Article  PubMed  Google Scholar 

  21. Aparicio T, Boige V, Sabourin JC, Crenn P, Ducreux M, Le Cesne A, Bonvalot S (2004) Prognostic factors after surgery of primary resectable gastrointestinal stromal tumours. Eur J Surg Oncol 30:1098–1103

    Article  PubMed  CAS  Google Scholar 

  22. Kovac D, Petrovecki M, Jasic M, Dobi-Babic R, Ivanis N, Rubinic M, Krizanac S, Jonjic N, Rizzardi C, Melato M (2002) Prognostic factors of gastrointestinal stromal tumors. Anticancer Res 22:1913–1917

    PubMed  Google Scholar 

  23. Muro-Cacho CA, Cantor AB, Morgan M (2000) Prognostic factors in malignant gastrointestinal stromal tumors. Ann Clin Lab Sci 30:239–247

    PubMed  CAS  Google Scholar 

  24. Nishida T, Nakamura J, Taniguchi M, Hirota S, Ito T, Kitamura Y, Matsuda H (2000) Clinicopathological features of gastric stromal tumors. J Exp Clin Cancer Res 19:417–425

    PubMed  CAS  Google Scholar 

  25. Taniguchi M, Nishida T, Hirota S, Isozaki K, Ito T, Nomura T, Matsuda H, Kitamura Y (1999) Effect of c-kit mutation on prognosis of gastrointestinal stromal tumors. Cancer Res 59:4297–4300

    PubMed  CAS  Google Scholar 

  26. Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492

    Article  PubMed  Google Scholar 

  27. Pross M, Manger T, Schulz HU, Lippert H, Roessner A, Gunther T (1999) Gastrointestinale Stromatumoren (GIST)-Probleme in Diagnostik und Therapie. Chirurg 70:807–812

    Article  PubMed  CAS  Google Scholar 

  28. Schneider-Stock R, Boltze C, Lasota J, Miettinen M, Peters B, Pross M, Roessner A, Gunther T (2003) High prognostic value of p16INK4 alterations in gastrointestinal stromal tumors. J Clin Oncol 21:1688–1697

    Article  PubMed  CAS  Google Scholar 

  29. Tryggvason G, Kristmundsson T, Orvar K, Jonasson JG, Magnusson MK, Gislason HG (2007) Clinical study on gastrointestinal stromal tumors (GIST) in Iceland, 1990–2003. Dig Dis Sci 52(9):2249–2253

    Article  PubMed  Google Scholar 

  30. Weber AG, Jovenin N, Lubrano D, Journu J, Yaziji N, Bouche O, Diebold MD, Delattre JF (2007) Outcome after surgical treatment of gastrointestinal stromal tumors. Gastroenterol Clin Biol 31:579–584

    Article  PubMed  Google Scholar 

  31. Jones OM, Rees M, John TG, Bygrave S, Plant G (2005) Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection. Brit J Surg 92:1165–1168

    Article  PubMed  CAS  Google Scholar 

  32. Raut CP, Morgan JA, Ashley SW (2007) Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol 23:149–158

    Article  PubMed  Google Scholar 

  33. Livraghi T, Lazzorini S, Meloni F, Solbiati L (2005) Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg 92(7):856–858

    Article  PubMed  CAS  Google Scholar 

  34. Qua CS, Wong CH, Goh KL (2008) Tumour seeding following percutaneous needle biopsy of hepatocellular carcinoma. Singapore Med J 49(1):e8–e11

    PubMed  CAS  Google Scholar 

  35. Perkins JD (2007) Seeding risk following percutaneous approach to hepatocellular carcinoma. Liver Transplant 33(5):437–447

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, University Friedrich-Schiller of Jena, Jena, Germany

    Konrad Klaus Richter, Constanze Schmid, Utz Settmacher & Annelore Altendorf-Hofmann

  2. Department of Surgery, University of Otago, Dunedin, New Zealand

    Mark Thompson-Fawcett

  3. Department of Surgery, Southland Hospital Invercargill, Kew Road, Invercargill, New Zealand

    Konrad Klaus Richter

Authors
  1. Konrad Klaus Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constanze Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark Thompson-Fawcett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Utz Settmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annelore Altendorf-Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konrad Klaus Richter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richter, K.K., Schmid, C., Thompson-Fawcett, M. et al. Long-term follow-up in 54 surgically treated patients with gastrointestinal stromal tumours. Langenbecks Arch Surg 393, 949–955 (2008). https://doi.org/10.1007/s00423-008-0318-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-008-0318-2

Keywords

Search

Navigation