title: Significance of surgery for prognosis of GIST in cohort from transitional healthcare settings.
abstract: OBJECTIVE
  Despite significant improvement in survival of gastrointestinal stromal tumors (GIST) due to use of tyrosine kinase inhibitors, surgery still represents the important part of clinical management. The aim of our study was to retrospectively analyze prognosis of GIST depending on the success of surgical treatments and utilization of chemotherapy in transitional country with relatively limited resources.
  
  
  METHODS
  cohort of consecutive patients operated for GIST in tertiary medical center, within time frame 1999-2012.
  
  
  RESULTS
  54 patients, in age range 20-85 years (63.3 ± 14.7), male to female ratio 28 (51.9%):26 (48.1%), respectively. Complete excision with clean resection margins (R0) was obtained in 44 (81.5%)of total patients i.e. 44/47 (93.6%) of localized GISTs. Mean follow up was 3.9 ± 3.3 years and 19 patients (35.2%) received imatinib. Rate of overall survival was 40 (74.1%), disease-free survival 31 (57.4%) and 20 (37.0%) experienced recidivism. Follow-up parameters showed significant difference in connection with utilization of imatinib, completeness of resection and existence of metastatic disease (all p < 0.05). ROC analyzes revealed critical value of Ki-67 > 9% as significant predictor of long-term mortality; sensitivity 64.3% [95%CI = 35.1-87.2]; specificity 75.0% [58.8-87.3]; (AUC = 0.693; p = 0.049).
  
  
  CONCLUSIONS
  Rate of complete resections in studied sample of patients from transitional background was overall peer comparable with reports from the developed countries. On the other hand, relatively dominant prognostic position of surgical treatments might be consequence of limited utilization of adjuvant treatment with tyrosine kinase inhibitors.
authors.affiliation: Department of Surgery, University Hospital Center "Sestre Milosrdnice" Zagreb, Croatia; Medical and Dental School University of Zagreb, Croatia. Electronic address: mario.zovak@kbcsm.hr.
authors.forename: Mario
authors.initials: M
authors.lastname: Zovak
authors.affiliation: Department of Internal Medicine, Medical School University of Osijek, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Boban
authors.affiliation: Department of Pediatrics, Children's Hospital Zagreb, Croatia; Medical School University of Zagreb, Croatia.
authors.forename: Ljubica
authors.initials: L
authors.lastname: Boban
authors.affiliation: Department of Surgery, University Hospital Center "Sestre Milosrdnice" Zagreb, Croatia; Medical and Dental School University of Zagreb, Croatia.
authors.forename: Slaven
authors.initials: S
authors.lastname: Cicek
authors.affiliation: Department of Surgery, University Hospital Center "Sestre Milosrdnice" Zagreb, Croatia; Medical and Dental School University of Zagreb, Croatia.
authors.forename: Zrinko
authors.initials: Z
authors.lastname: Madzar
authors.affiliation: Department of Clinical Oncology, University Hospital Center "Rebro", Zagreb, Croatia; Medical and Dental School University of Zagreb, Croatia.
authors.forename: Borislav
authors.initials: B
authors.lastname: Belev
authors.affiliation: Department of Clinical Pathology, University Hospital Center "Sestre Milosrdnice" Zagreb, Croatia; Medical School University of Zagreb, Croatia.
authors.forename: Davor
authors.initials: D
authors.lastname: Tomas
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use; D017523:Croatia / Q000453:epidemiology; D003906:Developing Countries; D018572:Disease-Free Survival; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
keywords: Adjuvant treatment; Complete resection; Gastrointestinal stromal tumor (GIST); Imatinib; Ki-67; Surgical treatment