Surgical therapy for gastrointestinal stromal tumours of the upper gastrointestinal tract.
OBJECTIVE
This study aimed to examine clinicopathological features and outcomes after primary resection of gastrointestinal stromal tumours (GIST) of the upper gastrointestinal tract


METHODS
Fifty consecutive patients were identified as having a mesenchymal tumour of the upper gastrointestinal tract resected at our institution, of which 47 were GISTs. The influence of clinicopathological variables on disease-free survival was evaluated using Kaplan-Meier estimates and Cox hazard model.


RESULTS
The median age was 62.8 (21.3-94.7). The commonest presenting symptoms were anaemia (43%) and pain (34%). Tumours were located in the stomach (64%), small bowel (34%) and oesophagus (2%). Median follow-up was 20.4 (2-106) months. Fletcher low/intermediate-risk tumours had a significantly better (p = 0.0008) 2- and 5-year actuarial survival of 100% compared with 88% and 58% for high-risk group. Recurrence-free survival at 2 and 5 years was 100% for low/intermediate-risk group compared with 68% and 45% for the high-risk group (p = 0.0008). Univariate analysis of predictors of recurrence identified male sex, high mitotic rate and tumour size as significant. Multivariate analysis showed high mitotic rate as the only poor prognosticator (Hazard ratio = 16.7, p = 0.02).


CONCLUSIONS
Surgical excision of low- and intermediate-grade GIST has an excellent prognosis. Surgery remains the mainstay of treatments, and high-grade tumours carry a significantly worse prognosis. High mitotic rates are an independent poor prognosticator.
Department of Surgery, Bankstown Hospital, University of New South Wales, Eldridge Rd, Bankstown, New South Wales, 2200, Australia.
Amitabha
A
Das
Robert
R
Wilson
Andrew V
AV
Biankin
Neil D
ND
Merrett
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007414:Intestinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D041742:Upper Gastrointestinal Tract / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult