Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables.
BACKGROUND
We sought to review the clinical presentation and outcomes of surgical management of gastrointestinal stromal tumours (GISTs).


METHODS
We reviewed clinical and pathological records of 41 patients (23 men and 18 women) with GISTs. We performed survival analyses using the Kaplan- Meier method and evaluated long-term survival and the independent prognostic factors that affect survival using univariate analyses. We used the Cox proportional hazards regression model to estimate the simultaneous effect on overall survival.


RESULTS
The stomach was the most common tissue of origin (n = 20, 48.8%). The mean tumour diameter was 8.3 cm. We detected advanced-stage tumours in 22 (53.7%) patients. We performed complete resection in 31 (75.6%) patients. Mitotic count was greater than 5/50 high-power field [HPF] in 22 (53.6%) patients. Immunohistochemical staining for CD117 was positive in 40 (97.6%) patients. Five patients (12.2%) died in the early postoperative period. The mean follow-up period was 38.7 months. The median length of survival was 53 months and the 5-year survival rate was 49.4%. Univariate analyses revealed significantly enhanced survival for the following variables: patient age less than 60 years (p = 0.011), male sex (p = 0.048), tumour diameter less than 5 cm (p = 0.029), low-risk tumour according to Fletcher classification (p = 0.022), complete resection (p < 0.001), and lack of local recurrence (p < 0.001) and/or metastasis (p < 0.001). Our Cox proportional hazards model revealed that complete tumour resection was the only factor to increase survival.


CONCLUSIONS
Overall survival is significantly affected by positive margins. A complete surgical resection with negative margins is the best method for definitive treatment of GISTs.
Unalp
Haluk R
HR
Izmir Ataturk Training and Research Hospital, Department of the fourth Surgical Clinics, Izmir, Turkey. halukunalp@gmail.com
Derici
Hayrullah
H
Kamer
Erdinc
E
Bozdag
Ali D
AD
Tarcan
Ercument
E
Onal
Mehmet A
MA
D000328:Adult; D000367:Age Factors; D000368:Aged; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate
D019009:Proto-Oncogene Proteins c-kit