Gastric gastrointestinal stromal tumors: therapeutic strategies and long-term prognosis

Abstract

Objectives

This study aimed to evaluate the clinical and prognostic characteristics of primary gastric gastrointestinal stromal tumors (GIST).

Methods

Patients who underwent resection for primary gastric GIST between January 2002 and December 2017 were included. Recurrence-free survival (RFS) was calculated by Kaplan–Meier analysis, and Cox proportional hazards model was used to identify independent prognostic factors.

Results

Altogether, 653 patients were enrolled. The median patient age was 59 years (range 15-86 years). Open, laparoscopic, and endoscopic resections were performed in 394 (60.3%), 105 (16.1%), and 154 (23.6%) patients, respectively. According to the modified NIH consensus classification, 132 (20.2%), 245 (37.5%), 166 (25.4%), and 88 (13.5%) patients were categorized into very low-, low-, intermediate-, and high-risk, respectively. A total of 136 (20.8%) patients received adjuvant imatinib treatment. The median follow-up time was 78 months (range 4–219 months), and the estimated 5-year RFS rate was 93.0%. In all patients, tumor size and rupture, mitotic counts, and adjuvant imatinib treatment were independent prognostic factors. The prognosis of gastric GIST treated with endoscopic resection was not significantly different from that of laparoscopic or open resection after adjusting for covariates using propensity score matching (log-rank p = .558). Adjuvant imatinib treatment (HR = 0.151, 95%CI 0.055–0.417, p < .001) was a favorable prognostic factor for high-risk patients, but was not associated with prognosis in intermediate-risk patients.

Conclusion

Patients with small gastric GISTs who successfully underwent endoscopic resection may have a favorable prognosis. Adjuvant imatinib treatment improve the prognosis of high-risk gastric GISTs, however, its use in intermediate-risk patients remains controversial.

Keywords:

• Gastric GIST
• endoscopic resection
• recurrence-free survival
• imatinib
• prognosis

Acknowledgments

None.

Authors contribution

Conception and design: Chunhui Shou, Zhou Chen, Zhijian Li and Jiren Yu. Administrative support: Jiren Yu. Provision of study materials or patients: Zhou Chen, Weili Yang and Qing Zhang. Collection and assembly of data: Chunhui Shou, Zhijian Li. Data analysis and interpretation: Chunhui Shou, Zhijian Li and Hao Bai. Manuscript writing: All authors. Final approval of manuscript: All authors.

Ethics statement

The study was approved by the Research Ethics Committee of the First Affiliated hospital, School of medicine, Zhejiang University.

Data availability statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.