Matteo Mandrioli1, Laura Mastrangelo1, Michele Masetti1, Nicola Zanini1, Stefania Lega2, Margherita Nannini3, Elisa Gruppioni4, Annalisa Altimari4, Angelo Paolo Dei Tos5, Carlo Fabbri6, Elio Jovine1. 1. Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy. 2. Department of Pathology, C. A. Pizzardi Maggiore Hospital, Bologna, Italy. 3. Department of Hematology and Oncology Sciences, L. A. Seragnoli, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 4. Molecular and Transplantation Pathology Laboratory, F. Addari Institute of Oncology, University of Bologna, Bologna, Italy. 5. Department of Pathology, General Hospital of Treviso, Treviso, Italy. 6. Division of Gastroenterology, C. A. Pizzardi Maggiore Hospital, Bologna, Italy.
Abstract
BACKGROUND: The recurrence rate, related to the unpredictable behavior of gastrointestinal stromal tumors (GISTs), continues to be a major topic of investigation, since no actual risk evaluation scales have proven to be exceedingly effective in predicting prognosis. We therefore focus in this study on investigating the predictive variables of disease recurrence. METHODS: Between September 2004 and January 2011, 34 patients, 18 males and 16 females with a median age of 62 (range, 27-87) years, underwent operations for primary, localized and advanced GISTs. Immunohistochemical profile, KIT and the platelet-derived growth factor receptor-alpha (PDGFR-α) gene mutations, tumor size, tumor site, mitotic index, synchronous tumors, adjuvant therapy, symptoms and gender were considered and analyzed as predictive variables. The receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for tumor dimension to predict recurrence. RESULTS: The median follow-up (FU) was 20 months (range, 6-86 months). A first-line adjuvant therapy was performed in nine patients. Disease relapse occurred in five cases. The tumor size and the mitotic index were the strongest predictive factors (P<0.001). The optimal maximum value for the tumor size was 7 cm [area under the curve (AUC) =0.955]. CONCLUSIONS: In light of the most recent evidence, a tumor size of 7 cm should be considered the threshold value for malignancy, and smaller GISTs with low mitotic counts as tumors with a low-grade risk.
BACKGROUND: The recurrence rate, related to the unpredictable behavior of gastrointestinal stromal tumors (GISTs), continues to be a major topic of investigation, since no actual risk evaluation scales have proven to be exceedingly effective in predicting prognosis. We therefore focus in this study on investigating the predictive variables of disease recurrence. METHODS: Between September 2004 and January 2011, 34 patients, 18 males and 16 females with a median age of 62 (range, 27-87) years, underwent operations for primary, localized and advanced GISTs. Immunohistochemical profile, KIT and the platelet-derived growth factor receptor-alpha (PDGFR-α) gene mutations, tumor size, tumor site, mitotic index, synchronous tumors, adjuvant therapy, symptoms and gender were considered and analyzed as predictive variables. The receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for tumor dimension to predict recurrence. RESULTS: The median follow-up (FU) was 20 months (range, 6-86 months). A first-line adjuvant therapy was performed in nine patients. Disease relapse occurred in five cases. The tumor size and the mitotic index were the strongest predictive factors (P<0.001). The optimal maximum value for the tumor size was 7 cm [area under the curve (AUC) =0.955]. CONCLUSIONS: In light of the most recent evidence, a tumor size of 7 cm should be considered the threshold value for malignancy, and smaller GISTs with low mitotic counts as tumors with a low-grade risk.
Authors: H Joensuu; P J Roberts; M Sarlomo-Rikala; L C Andersson; P Tervahartiala; D Tuveson; S Silberman; R Capdeville; S Dimitrijevic; B Druker; G D Demetri Journal: N Engl J Med Date: 2001-04-05 Impact factor: 91.245
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