title: Gastrointestinal stromal tumors (GISTs), 10-year experience: patterns of failure and prognostic factors for survival of 127 patients.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) and are believed to originate from the interstitial cell of Cajal. Management of GIST has evolved very rapidly in the last decade.
  
  
  OBJECTIVE
  To report our surgical experience in the treatment of GIST patients, to evaluate the prognostic factors and to discuss some controversial issues about the role of target therapy.
  
  
  METHODS
  One hundred and twenty seven consecutive patients who underwent surgical resection for GISTs at Nasser Institute (98 patients) and NCI, Cairo University (29 patients) from January 2000 to December 2009 were reviewed retrospectively. The clinical and pathological features of patients were collected. Also data about treatment variables, patterns of failure and factors that predict survival were collected and analyzed.
  
  
  RESULTS
  Of the 127 patients, 81 (64%) had primary disease without metastasis, 11 (9%) had metastatic lesions at presentation, and 35 (27%) presented with recurrence (isolated, metastasis or both). Patients with primary disease underwent complete resection of gross disease. The 5-year overall survival was 53.4% and disease free survival (DFS) was 46.5%. The median DFS was 43.0months (95% CI: 21.2-64.9). On multivariate analysis, survival was affected by mode of presentation, gastric origin and tumor size. Failures after resection were predominantly intra-abdominal (original site, peritoneal, and liver), and rarely lungs.
  
  
  CONCLUSIONS
  Surgical resection is the mainstay of treatment of GIST. Tumor size and gastric origin were the predicators for DFS in patients presenting with primary disease.
authors.affiliation: Department of Surgical Oncology, National Cancer Institute, Cairo University, 29 Abdel Aziz Aal Seoud, Manial, Cairo, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Al-Kalaawy
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El-Zohairy
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mostafa
authors.forename: A
authors.initials: A
authors.lastname: Al-Kalaawy
authors.forename: H
authors.initials: H
authors.lastname: El-Sebae
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D055815:Young Adult