Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors
Kazım Şenol1,2, Gül Dağlar Özdemir3, Arif Zeki Akat3, Nuri Aydın Kama4
1Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey
2Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
3Department of General Surgery, Health Sciences University School of Medicine, Ankara, Turkey
4Department of General Surgery, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
Objective: The aim of this study was to evaluate the prognostic factors effecting recurrence risk and disease-free survival of the patients who were diagnosed as gastrointestinal stromal tumor after complete resection of the tumor with or without adjuvant therapy.
Material and Methods: Between the years 2005 and 2013, data of 71 patients including clinical and demographic features, tumor localizations, pathologic examinations, survival and recurrence rates were enrolled into this retrospective study.
Results: Male/female ratio was 1.71, and mean age was 60.27 ± 14.65 years. Forty-two (59.2%) patients had tumor in stomach, 16 (22.5%) in small bowel, whereas 12 (16.9%) had extra-gastrointestinal system and one patient (%1.4) had rectal localization. Modified NIH risk stratification scheme categorized 9 (12.68%) patients in very low-, 12 (16.90%) in low-, 21 (29.58%) patients in moderate-and 29 (40.85%) patients in high-risk group. Twenty-four (33.8%) patients had a metastatic disease at follow-up while 13 (18.3%) patients were metastatic at admission. R0 resection was successfully performed in 51 (71.8%) patients, while R1 resection in 9 (12.7%) and R2 resection in 11 (15.5%) were achieved. Mean follow-up time was 47.12 ± 33.52 months (range, 1-171 months). Nineteen (26.8%) patients demonstrated recurrence with a mean time of 22.16 ± 15.89 months (range, 3-57 months). During follow-up 17 (23.9%) patients were deceased. In univariate analysis, high-risk group, small bowel and extra-gastrointestinal system localization, R1-2 resection, necrosis, positive resection margin and invasion of surrounding tissues, metastatic disease and adjuvant therapy were statistically significant in terms of recurrence. Multivariate analysis presented small bowel and extra-gastrointestinal system localization, R2 resection, mitoses count, invasion and adjuvant therapy as independent prognostic risk factors affecting disease-free survival rates. The 1, 3 and 5 years of disease-free survival rates of the patients were 89.6%, 75.4%, 64.3%, respectively.
Conclusion: As mentioned in the literature, the mainstay of curative therapy of gastrointestinal stromal tumor is surgery. In our study, not only small bowel, extra-gastrointestinal system localization and invasion of surrounding tissues by tumor, but also R2 resection that complicate the local control of the disease were represented as independent adverse prognostic factors for disease-free survival. Unfavourable clinical outcomes of adjuvant therapy over the disease-free survival was linked to higher tumor stage with metastatic disease and emphasized that prospective trials with more cases should be practiced.
Keywords: Gastrointestinal stromal tumors, surgery, prognosis, disease specific survival
Cite this article as: Şenol K, Dağlar Özdemir G, Akat AZ, Kama NA. Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors. Turk J Surg 2020; 36 (2): 209-217.
Approval was obtained from the Ankara Numune Training and Research Hospital Scientific Research Evaluation Commission for the study (Date: 29.01.2014, Decision no: 2014-748).
Informed consent form was obtained from all patients.
Concept – K.S., G.D.Ö.; Design – K.S.; Supervision – G.D.Ö., N.A.K., A.Z.A.; Materials – G.D.Ö., N.A.K., A.Z.A.; Data Collection and/or Processing – K.S.; Analysis and Interpretation – K.S., G.D.Ö.; Literature Review – K.S., G.D.Ö.; Writing Manuscript – K.S.; Critical Reviews – G.D.Ö.
The authors have no conflicts of interest.
Financial support was provided by departmental sources.
We thank our colleagues from the General Surgery Department who performed the operations. We also thank the anonymous reviewers for their useful suggestions.