Stromal Gastrointestinal tumors: Retrospective study about 24 cases

##plugins.themes.academic_pro.article.sidebar##

Published Dec 10, 2013
Download
pdf
Vol. 91 No. 11 (2013): Issue Nov 2013

##plugins.themes.academic_pro.article.main##

Hanène Boudabous
Youssef Chaker
Ramzi Nouira
Chadli Dziri

Abstract

Background: Gastrointestinal stromal tumors (GIST) are the most common digestive sarcomas. They develop in most cases in the stomach and small intestine, more rarely rectum, colon, esophagus or mesentery. These tumors typically express the phenotype CD117/KIT + and CD34 +.
aim : To evaluate epidemiologic, clinical, pathologic, therapeutic, characteristics and evaluative pattern of gastrointestinal tumor treated in our surgical department.
Patients and methods : We collected 24 cases of GIST (confirmed by the positivity of CD 117 and/or CD 33) treated between 1997 and 2010 in the department of surgery B of Charles Nicolle’s Hospital. We analyzed demographic characteristics, clinic pattern, investigations treatment and therapeutic variables of our patients. We calculated the survival rate and identified prognostic predictive factors of survival.
results : Our retrospective study interested, during 13 years, 24 patients presenting GIST with a median age of 66 years and a sex ratio of 0.8. The median time for diagnosis was two months (3 days to 24 months). Abdominal pain, gastrointestinal bleeding and vomiting were the most common symptoms. The endoscopic appearance was tumor arising from muscular layer found in the stomach (13/24 cases; 54%), small bowel in four cases (16.5%) and duodenal or rectum three patients (12,5 %). Twenty three within 24 patients underwent surgical resection with R0 in 20/23 cases. Three patients were treated with neoadjuvant imatinib for an average of 12 months, one patient had adjuvant treatment and four patients in locoregional evolutive tumor and / or metastatic. The overall survival was 70% at one year and 65% at two years with a pejorative impact, in univariate analysis of abdominal pain, asthenia, anorexia, weight loss, cytonuclear atypia, tumor size ≥ 10 cm and a mitotic index ≥ 5/50. Multivariate analysis showed that tumor size (Hazard Ratio = 6 if size ≥ 10 cm 95% CI [1,539-24,017]) and weight loss (Hazard Ratio = 7 95% CI [1,664-29,100]) were influential factors on overall survival and recurrence-free survival.
Conclusion : The prognostic predictive factors identified were the size of tumor ≥ 10cm and the mitotic index.

Keywords:

Gastrointestinal tumors, Imatinib, surgery, prognosis factors.

##plugins.themes.academic_pro.article.details##

References

  1. Miettinen M, Lasota J. Gastrointestinal stromal tumors : definition, clinical, histological, immunohistochemical and molecular genetic features and differential diagnosis. Virchows Arch 200;438:1-12.
  2. Joensu H. Gastrointestinal stromal tumor (GIST). Ann Oncol 2006; 17:280-6.
  3. Fletcher CD, Berman JJ, corless C et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002; 33:459-65.
  4. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis and differential diagnosis. Arch Pathol Lab Med 2006;130:1466-8.
  5. Lahmar-Boufaroua A, Ben Slama S, Bouraoui S et al. Review of 32 gastro-intestinal stromal tumours with CD117 antigen. Tunis Med. 2009; 87:133-6.
  6. Bedioui H, Jouini M, Bouzaiene H et al. Gastrointestinal stromal tumours: clinical and therapeutic features. A report of 25 cases. Tunis Med. 2006 ; 84 :599-602.
  7. Bellil K, Haouet S, Bellil-Ben Haha S et al. Gastrointestinal stromal tumor: epidemiology and outcome study in 40 cases. Tunis Med. 2006 ; 84 :26-9.
  8. Andre JB, Coindre JM, Cvitkovic F. Tumeurs stromales digestives. Gastroenterol Clin Biol 2001; 25:473-82.
  9. H. Joensuu, P.J. Roberts, M. Sarlomo-Rikala et al. Brief Report: Effect of the Tyrosine Kinase Inhibitor STI571 in a Patient with a Metastatic Gastrointestinal Stromal Tumor. N. Engl. J. Med2001; 344:1052-6.
  10. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group, A.T. Van Oosterom, I.R. Judson, J. Verweij et al. Update of phase I study of imatinib (STI 571) in advanced soft tissue sarcomas and gastrointestinal stromal tumors: a report of the EORTC Soft Tissue and Bone Sarcoma Group. Eur. J. Cancer2002; 38:S83-S87.
  11. J. Verweij, A. Van Oosterom, J.Y. Blay et al. Imatinib mesylate (STI-571 Glivec®, Gleevec®) is an active agent for gastrointestinal stromal tumours, but does not yield responses in other soft-tissue sarcomas that are unselected for a molecular target.Results from an EORTC Soft Tissue and Bone Sarcoma Group phase II study. Eur. J. Cancer 2003; 39:2006-11.
  12. G.D. Demetri, M. Von Mehren, C.D. Blanke et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N. Engl. J. Med 2002; 347:472-80.
  13. S. Silberman, H. Joensuu. Overview of issues related to imatinib therapy of advanced gastrointestinal stromal tumors: a discussion among the experts. Eur J Cancer 2002; 38:S66-S69.
  14. J.R. Zalberg, J. Veirveij, P Casali et al. Outcome of patients with advanced gastrointestinal stromal tumors (GIST) crossing over to a daily imatinib dose of 800 mg after progression on 400mg An international intergroup study on the EORTC,ISG, and AGITG Proceedings ASCO 2004; 23: abstract 9004.
  15. Choi H, Charnsangavej C, De Castro Faria S et al. CT Evaluation of the Response of Gastrointestinal Stromal Tumors After Imatinib Mesylate Treatment: A Quantitative Analysis Correlated with FDG PET Findings. AJR Am J Roentgenol 2004; 183: 1619-28.
  16. Demetri GD, Von Mehren M, Antonescu CR et al. NCNN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010; 8:S1-41.
  17. Vanel D, Albiter M, Shapeero L et al. Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment: a prospective study of 54 patients. Europan Journal of Radiology 2005, 54: 118-23.
  18. Le Cesne A, Landi B, Bonvalot S et al. Recommandations pour la prise en charge des tumeurs stromales gastro-intestinales. Hépato- Gastroduodénale 2005; 5:377-9.
  19. Casali PG, Jost L, Reichardt P, Schlemmer M, Blay. JYESMO Guidelines Working Group. Gastrointestinal stromal tumors: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20:35-8.
  20. Cao H, Zhang Y, Wang M et al. Prognostic analysis of patients with gastrointestinal stromal tumors: a single unit experience with surgical treatment of primary disease. Chinese Medical Journal 2010; 123:131-6.
  21. Landi B, Leomte T, Cellier C. Tumeurs stromales digestives : diagnostic et pronostic. La lettre de l'hépatogastroentérologue2002; 5:66-9.
  22. Miettinen M, EL-Rifai W, Leslie H et al. Evaluation of malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Hum Pathol2002; 33:478-83.
  23. Boudet MJ, De Mestier P. Les tumeurs stromales du tube digestif. J Chir 2001 ; 138 :104-8.
  24. Chang MS, Choe G, Kim WH, Kim YI. Small intestinal stromal tumors: a clinic pathologie study of 31 tumors. Pathol Int 1998; 48:341-7.
  25. Pidhorecky I, Cheney RT, Kraybill WG et al. Gastrointestinal stromal tumors: current diagnosis, biologic behavior and management. Ann Surg Oncol 2000;7:705-12.
  26. Pierie JP, Choudry U, Muzikansky A et al. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001; 136:383-9.
  27. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008; 39:1411-19.