F Duffaud1, P Meeus2, J B Bachet3, P Cassier4, T K Huynh5, E Boucher6, O Bouché7, V Moutardier8, A le Cesne9, B Landi10, F Marchal11, J O Bay12, F Bertucci13, J P Spano14, E Stoeckle15, O Collard16, L Chaigneau17, N Isambert18, V Lebrun-Ly19, J Mancini20, J Y Blay4, S Bonvalot21. 1. Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France. Electronic address: fduffaud@mail.ap-hm.fr. 2. Service de Chirurgie, Centre Léon Bérard, Lyon, France. 3. Service d'Hépato-gastroentérologie, CHU Pitié Salpétrière, Paris, France. 4. Service d'Oncologie Médicale, Centre Léon Bérard, Lyon, France. 5. Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France. 6. Service d'Oncologie médicale, Centre Eugène Marquis, Rennes, France. 7. Service d'Oncologie digestive, CHU de Reims, France. 8. Service de Chirurgie digestive, CHU Nord, Marseille, France. 9. Service d'Oncologie médicale, Institut Gustave Roussy, Villejuif, France. 10. Service de Gastro-entérologie et Oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France. 11. Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France. 12. Service d'oncologie médicale, CHU Clermont Ferrand, France. 13. Service d'Oncologie médicale, Institut Paoli Calmettes, Marseille, France. 14. Service d'Oncologie médicale, CHU Pitié Salpétrière, Paris, France. 15. Service d'Oncologie médicale, Institut Bergonié, Bordeaux, France. 16. Service d'Oncologie Médicale, CLCC, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France. 17. Service d'oncologie médicale, CHU de Besançon, France. 18. Oncologie médicale, Centre G Leclerc, Dijon, France. 19. Service d'Oncologie médicale, CHU Dijon, France. 20. Service de Santé Publique et d'Information Médicale, Unité de Biostatistiques, CHU Timone, Marseille, and Aix-Marseille Université (AMU), France. 21. Service de Chirurgie, Institut G Roussy, Villejuif, France.
Abstract
BACKGROUND: Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs. METHODS: Patients were identified via a survey from 16 FSG centers (n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation. RESULTS: 114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were R0 (n = 87, 79%), R1 (n = 8, 7%), R2 (n = 6). Tumor characteristics were: KIT+ (n = 104), CD34+ (n = 58). Miettinen risk was low (n = 43), and high (n = 52). Imatinib was administered preoperatively (n = 11) and post-operatively (n = 20). With a median follow-up of 36 months (2-250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups (P > 0.05). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse. CONCLUSIONS: Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD.
BACKGROUND: Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs. METHODS:Patients were identified via a survey from 16 FSG centers (n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation. RESULTS: 114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were R0 (n = 87, 79%), R1 (n = 8, 7%), R2 (n = 6). Tumor characteristics were: KIT+ (n = 104), CD34+ (n = 58). Miettinen risk was low (n = 43), and high (n = 52). Imatinib was administered preoperatively (n = 11) and post-operatively (n = 20). With a median follow-up of 36 months (2-250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups (P > 0.05). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse. CONCLUSIONS:Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD.
Authors: Ser Yee Lee; Brian K P Goh; Eran Sadot; Rahul Rajeev; Vinod P Balachandran; Mithat Gönen; T Peter Kingham; Peter J Allen; Michael I D'Angelica; William R Jarnagin; Daniel Coit; Wai Keong Wong; Hock Soo Ong; Alexander Y F Chung; Ronald P DeMatteo Journal: Ann Surg Oncol Date: 2016-09-13 Impact factor: 5.344
Authors: Hamda Almaazmi; Miloslawa Stem; Brian D Lo; James P Taylor; Sandy H Fang; Bashar Safar; Jonathan E Efron; Chady Atallah Journal: J Gastrointest Surg Date: 2019-08-06 Impact factor: 3.452
Authors: Juan Manuel Sanchez-Hidalgo; Manuel Duran-Martinez; Rafael Molero-Payan; Sebastian Rufian-Peña; Alvaro Arjona-Sanchez; Angela Casado-Adam; Antonio Cosano-Alvarez; Javier Briceño-Delgado Journal: World J Gastroenterol Date: 2018-05-14 Impact factor: 5.742