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Risk Criteria and Prognostic Factors for Predicting Recurrences After Resection of Primary Gastrointestinal Stromal Tumor

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The introduction of adjuvant imatinib in gastrointestinal stromal tumors (GISTs) raised debate over the accuracy of National Institutes of Health risk criteria and the significance of other prognostic factors in GIST.

Methods

Tumor aggressiveness and other clinicopathological factors influencing disease-free survival (DFS) were assessed in 335 patients with primary resectable CD117-immunopositive GISTs (median follow-up, 31 months after primary tumor resection) from a prospectively collected tumor registry.

Results

Overall median DFS was 37 months, and estimated 5-year DFS was 37.8 %. In univariate analysis, high or intermediate risk group (P < .000001), mitotic index >5/50 high-power field (P < .00001), primary tumor size >5 cm (P < .00001), nongastric primary location (P = .0001), male sex (P = .01), R1 resection/tumor rupture (P = .0003), and epithelioid cell or mixed cell pathological subtype (P = .05) negatively affected DFS. In multivariate analysis, statistically significant factors negatively influencing DFS for model 1 were mitotic index >5/50 high-power field (P = .004), primary tumor size >5 cm (P = .001), male sex (P = .003), R1 resection/tumor rupture (P = .04), and nongastric primary tumor location (P = .02), and for model 2 were high/intermediate risk primary tumor (P < .0001 and P = .008, respectively), male sex (P = .007), resection R1/tumor rupture (P = .01), and nongastric primary tumor location (P = .02). Five-year DFS for high, intermediate, and low/very low risk group was 20%, 54%, and 96%, respectively.

Conclusions

The risk criteria for assessing the natural course of primary GISTs were validated, but additional independent prognostic factors—primary tumor location and sex—were also identified.

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Acknowledgments

Supported by the Polish State Committee for Scientific Research, grant 3P05C05925. We thank all doctors devoted to GIST treatment and diagnosis who collaborated in the Polish Clinical GIST Registry, M. Rosinska for statistical advice, and J. Lasota (Armed Forces Institute of Pathology, Washington, DC) for critical remarks and mutational analyses data.

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Authors and Affiliations

  1. Department of Soft Tissue/Bone Sarcoma and Melanoma, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland

    Piotr Rutkowski MD, PhD, Zbigniew I. Nowecki MD, PhD, Zbigniew Żurawski MD & Włodzimierz Ruka MD, PhD

  2. Department of Pathology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland

    Wanda Michej MD

  3. Center for Human Genetics, University of Leuven, O&N Gasthuisberg Herestraat 49, 3000, Leuven, Belgium

    Maria Dębiec-Rychter MD, PhD

  4. Department of Biology and Genetics, Medical University of Gdansk, Debinki 1, 80-211, Gdansk, Poland

    Agnieszka Woźniak PhD & Janusz Limon PhD

  5. Department of Molecular Biology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland

    Janusz Siedlecki PhD

  6. Department of Radiology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland

    Urszula Grzesiakowska MD, PhD

  7. Regional Oncological Center, Marii C. Sklodowskiej 2, 80-210, Gdansk, Poland

    Michał Kąkol MD

  8. Department of General Surgery, Jagiellonian University, Kopernika 40, 31-501, Cracow, Poland

    Czesław Osuch MD, PhD

  9. Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland

    Marcin Polkowski MD, PhD

  10. City Hospital, Grunwaldzka 45, 25-736, Kielce, Poland

    Stanisław Głuszek MD, PhD

Authors
  1. Piotr Rutkowski MD, PhD
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  2. Zbigniew I. Nowecki MD, PhD
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Correspondence to Piotr Rutkowski MD, PhD.

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Rutkowski, P., Nowecki, Z.I., Michej, W. et al. Risk Criteria and Prognostic Factors for Predicting Recurrences After Resection of Primary Gastrointestinal Stromal Tumor. Ann Surg Oncol 14, 2018–2027 (2007). https://doi.org/10.1245/s10434-007-9377-9

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  • DOI: https://doi.org/10.1245/s10434-007-9377-9

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