title: Recurrence risk after resection of gastrointestinal stromal tumors: size is not all that matters... The consequences of tumor rupture.
abstract: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that most commonly have activating mutations in KIT. Recurrence after complete resection remains a significant problem, and the ability to identify patients at high risk for recurrence would allow for selective use of adjuvant  therapies such as imatinib in patients who may garner the most benefit. Initial staging systems stratified recurrence risk by tumor size and mitotic index, whereas subsequent staging systems also included tumor location. However, other clinical factors may influence prognosis and the risk  for tumor recurrence after surgery. The purpose of this article is to highlight tumor rupture as an additional risk factor that should be considered when assessing for recurrence risk. Tumor rupture is associated with decreased survival and increased recurrence rates, but it is not universally  included in current staging systems. Patients with ruptured GISTs may not meet the risk criteria elaborated in some current staging systems, yet these patients are at high risk for tumor recurrence and may benefit from adjuvant imatinib therapy. A fundamental understanding of all the risk  factors for tumor recurrence, including tumor rupture, and appropriate consideration for adjuvant therapy through a multidisciplinary approach are requisite for the maximal prevention of disease recurrence.
authors.affiliation: Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Han
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Deneve
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010879:Piperazines / Q000627:therapeutic use; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use; D012307:Risk Factors; D012421:Rupture; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate