medigraphic.com
ISSN 1561-3186 (Electronic)

2021, Number 1

<< Back Next >>

Rev Acta Médica 2021; 22 (1)

Clinical and pathological characteristics of patients with gastrointestinal stromal tumors

Soriano GJL, Lima PM, Fleites CV, Domínguez AC, González MM, Fernández SLT, Morales MD, Hernández CJL, Concepción IR, Ortiz RJ, Batista AN, González SME

Language: Spanish
References: 39
Page:
PDF size: 374.11 Kb.


ABSTRACT

Introduction: Gastrointestinal stromal tumors are tumors with a very low incidence. In Cuba, there is a protocol for their diagnosis and treatment. Yet few publications have been made about this disease at the national level.
Objective: To describe the clinical and histopathological characteristics of patients with gastrointestinal stromal tumors (GIST) in Cuba.
Methods: A retrospective and observational study was carried out in 354 patients with a diagnosis of gastrointestinal stromal tumors treated at Hermanos Ameijeiras Clinical-Surgical Hospital between 2003 and 2020. The chi-square method was used for the association of variables, with P<0.05. Overall survival was evaluated.
Results: 96.9% of the patients were positive for CD117. There was a predominance of patients older than 50 years, of white skin, female sex, and in early stages of the disease. The most frequently observed form of presentation was abdominal pain, accounting for 37.1%, together with the gastric location. The median tumor size was ten centimeters. In nonmetastatic stages, according to different classifications, high-risk patients predominated, mainly for nongastric locations (P<0.05). The liver and peritoneum were the most frequently observed metastatic sites. Surgery was performed in 89.5% of the patients, although the compromised resection and tumor rupture margins were observed in 22.3% and 16.4% of patients, respectively. 70.1% of all patients received treatment with imatinib. The volume of new patients and their overall survival increased gradually. Median survival has not yet been reached, at least within the last two triennia.
Conclusions: This constitutes the most complete report of the epidemiological, clinical and histopathological characteristics of patients with gastrointestinal stromal tumors in Cuba, in the context of a national protocol.


REFERENCES

  1. Ahmed M. Recent advances in the management of gastrointestinal stromal tumor. World J Clin Cases. 2020;8(15):3142-55. DOI: https://doi.org/10.12998/wjcc.v8.i15.3142

  2. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gainof- function mutations of c-kit gene in human gastrointestinal stromal tumor. Science. 1998;279:577-580. DOI: https://doi.org/10.1126/science.279.5350.577

  3. Kindblom LG, Remotti HE, Aldenborg F, Meis Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): Gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol. 1998;152:1259-69. PMID:9588894

  4. Huss S, Pasternack H, Ihle MA, Merkelbach Bruse S, Heitkötter B, Hartmann W, et al. Clinicopathological and molecular features of a large cohort of gastrointestinal stromal tumors (GISTs) and review of the literature: BRAF mutations in KIT/PDGFRA wild-type GISTs are rare events. Hum Pathol. 2017;62:206-14. DOI: https://doi.org/10.1016/j.humpath.2017.01.005

  5. Kalfusova A, Linke Z, Kalinova M, Krskova L, Hilska I, Szabova J, et al. Gastrointestinal stromal tumors - Summary of mutational status of the primary/secondary KIT/PDGFRA mutations, BRAF mutations and SDH defects. Pathol Res Pract. 2019;215(12):152708. DOI: https://doi.org/10.1016/j.prp.2019.152708

  6. Bombac A, Zakotnik B, Bucic M, Setrajcic Dragos V, Gazic B, Stegel V, et al. Mutational spectrum and classification of novel mutations in patients with metastatic gastrointestinal stromal tumours. Int J Oncol. 2020;56(6):1468-78. DOI: https://doi.org/10.3892/ijo.2020.5028

  7. Watson GA, Kelly D, Melland Smith M. Get the GIST? An overview of gastrointestinal stromal tumours. Ir J Med Sci. 2016;185(2):319-26. DOI: https://doi.org/10.1007/s11845-016-1410-1

  8. Ma GL, Murphy JD, Martinez ME, Sicklick JK. Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study. Cancer Epidemiol Biomarkers Prev. 2015;24:298-302. DOI: https://doi.org/10.1158/1055-9965.EPI-14-1002

  9. Rammohan A, Sathyanesan J, Rajendran K, Pitchaimuthu A, Perumal SK, Srinivasan U, et al. A gist of gastrointestinal stromal tumors: a review. World J Gastrointest Oncol. 2013;5:102-12. DOI: https://doi.org/10.4251/wjgo.v5.i6.102

  10. Zhang H, Liu Q. Prognostic Indicators for Gastrointestinal Stromal Tumors: A Review. Transl Oncol. 2020;13(10):100812. DOI: 10.1016/j.tranon.2020.100812

  11. Joenssu H, Roberts P, Sarlomo Rikala M, Andersson LC, Tervahartiala P, Tuveson D, et al. Effect of the Tyrosine Kinase inhibitor STI571 in a patient with metastatic gastro-intestinal stromal tumor. N Engl J Med 2001;344(14):1052-6. DOI: https://doi.org/10.1056/NEJM200104053441404

  12. Lima M, Soriano J, González J, Domínguez C, Iglesias N, Copo J, et al. Sarcomas del estroma gastrointestinal tratados con Imatinib: presentación de 2 casos. Rev cubana med. 2006[acceso: 30/8/2020];45(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232006000200009

  13. Lima M, Soriano JL, Batista N, Domínguez C, Rodríguez M, Martín M, et al. Sarcomas del estroma gastrointestinal (GIST). En: Manual de Prácticas Médicas IV Edición. Unidad Funcional de Tumores. Tomo 2. La Habana: Editorial de Ciencias Médicas, 2012. pp. 682-98.

  14. Brierley JD, Gospodarowicz MK, Wittekind C. (eds). TNM Classification of Malignant Tumours, 8th ed. Oxford, United Kingdom: John Wiley & Sons, Inc. 2016.

  15. Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, and ESMO Guidelines Committee and EURACAN. Gastrointestinal stromal tumours: ESMOEURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv267. DOI: https://doi.org/10.1093/annonc/mdy320 15. Sánchez-Hidalgo JM, Duran Martínez M, Molero Payan R, Rufián Peña S, Arjona Sánchez A, Casado-Adam A, et al. Gastrointestinal stromal tumors: A multidisciplinary challenge. World J Gastroenterol. 2018;24(18):1925-41. DOI: https://doi.org/10.3748/wjg.v24.i18.1925

  16. Laurini JA, Blanke CD, Cooper K, Demetri GD, Dematteo RP, Fletcher CDM, et al. College of American Pathologist. Protocol for the examination of specimens from patients with gastrointestinal stromal tumor. Version: GIST 4.0.1.0. June 2017[acceso: 30/8/2020]. Disponible en: https://webapps.cap.org/apps/docs/committees/cancer/cancer_protocols/2012 /GIST_12protocol_3021.pdf

  17. Poveda A, García Del Muro X, López Guerrero JA, Cubedo R, Martínez V, Romero I, et al. GEIS guidelines for gastrointestinal sarcomas (GIST). Cancer Treat Rev. 2017;55:107-19. DOI: https://doi.org/10.1016/j.ctrv.2016.11.011

  18. von Mehren M, Joensuu H. Gastrointestinal Stromal Tumors. J Clin Oncol. 2018;36(2):136-43. DOI: https://doi.org/10.1200/JCO.2017.74.9705

  19. Parab TM, DeRogatis MJ, Boaz AM, Grasso SA, Issack PS, Duarte DA, et al. Gastrointestinal stromal tumors: a comprehensive review. J Gastrointest Oncol. 2019;10(1):144-54. DOI: https://doi.org/10.21037/jgo.2018.08.20

  20. Soreide K, Sandvik OM, Soreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39-46. DOI: https://doi.org/10.1016/j.canep.2015.10.031

  21. Medrano R, Meza NK, Silverio JR, González G. Factores pronósticos de recurrencia y supervivencia en tumores del estroma gastrointestinal. Experiencia del Hospital de Oncología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. Gaceta Mex Oncol. 2015;14(5):259-67. DOI: https://doi.org/10.1016/j.gamo.2015.11.002

  22. Giuliano K, Nagarajan N, Canner J, Najafian A, Wolfgang C, Schneider E, et al. Gastric and small intestine gastrointestinal stromal tumors: Do outcomes differ? J Surg Oncol. 2017;115(3):351-7. DOI: https://doi.org/10.1002/jso.24514

  23. Manrique MN, Soriano C, Yábar A, Frisancho O, Palacios AM. Tumores estromales gastrointestinales: evaluación clinicopatológica y sobrevida en el Hospital Rebagliati. Rev Gastroenterol Perú. 2012[acceso:1/10/2020];32(4):357- 65. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1022- 51292012000400004&lng=es

  24. Calderillo G, Muñoz Medel M, Carbajal E, Córdova Delgado M, Durán D, Retamal IN, et al. Retrospective analysis of chilean and mexican GI stromal tumor registries: a tale of two Latin American realities. JCO Glob Oncol. 2020;6:647-57. DOI: https://doi.org/10.1200/JGO.19.00410

  25. Li J, Zhang H, Chen Z, Su K. Clinico-pathological characteristics and prognostic factors of gastrointestinal stromal tumors among a Chinese population. Int J Clin Exp Pathol. 2015;8(12):15969-76. PMID: 26884871

  26. Ngo QD, Pham QT, Phan DAT, Hoang AV, Hua TNH, Nguyen ST. Molecular and Clinicopathological Features of Gastrointestinal Stromal Tumors in Vietnamese Patients. J Pathol Transl Med. 2019;53(6):361-8. DOI: https://doi.org/10.4132/jptm.2019.08.27

  27. Togo A, Traoré A, Dembélé BT, Diakité I, Traoré A, Konaté M, et al. Gastrointestinal stromal tumors (GIST): The particularities aspects in African countries. Bull Cancer. 2018;105(2):212-3. DOI: https://doi.org/10.1016/j.bulcan.2017.10.029

  28. Monges G, Bisot Locard S, Blay JY, Bouvier AM, Urbieta M, Coindre JM, et al. The estimated incidence of gastrointestinal stromal tumors in France. Results of PROGIST study conducted among pathologists. Bull Cancer. 2010;97(3):E16-22. DOI: https://doi.org/10.1684/bdc.2010.1041

  29. Sorour MA, Kassem MI, Ghazal Ael-H, El-Riwini MT, Abu Nasr A. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg. 2014;12(4):269-80. DOI: https://doi.org/10.1016/j.ijsu.2014.02.004

  30. Zhou Y, Hu W, Chen P, Abe M, Shi L, Tan SY, et al. Ki67 is a biological marker of malignant risk of gastrointestinal stromal tumors: a systematic review and metaanalysis. Medicine (Baltimore). 2017;96(34):e7911. DOI: https://doi.org/10.1097/MD.0000000000007911

  31. Soriano Lorenzo J, Lima Pérez M, Soriano García J, Zaldívar Blanco K, Fleites Calvo V. Tumores del estroma gastrointestinal. An Fac med. 2019;80(2):214-21. DOI: https://doi.org/10.15381/anales.802.16418

  32. Nishida T, Cho H, Hirota S, Masuzawa T, Chiguchi G, Tsujinaka T, et al. Clinicopathological features and prognosis of primary gists with tumor rupture in the real world. Ann Surg Oncol. 2018;25(7):1961-9. DOI: https://doi.org/10.1245/s10434-018-6505-7

  33. Poveda A, Martinez V, Serrano C, Sevilla I, Lecumberri MJ, de Beveridge RD, et al. SEOM Clinical Guideline for gastrointestinal sarcomas (GIST) (2016). Clin Transl Oncol. 2016;18(12):1221-8. DOI: https://doi.org/10.1007/s12094-016-1579-9

  34. Di Lauro K, Manigrasso M, Milone F, Rosati R. Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors. Eur J Surg Oncol. 2017;43:796-800. DOI: https://doi.org/10.1016/j.ejso.2017.01.005

  35. Xiao B, Peng J, Tang J, Zhang R, Li C, Lin J, et al. Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res. 2018;10:6121-7. DOI: https://doi.org/10.2147/CMAR.S187061

  36. Reichardt P, Blay JY, Boukovinas I, Brodowicz T, Broto JM, Casali PG, et al. Adjuvant therapy in primary GIST: state-of-the-art. Ann Oncol. 2012;23(11):2776- 81. DOI: https://doi.org/10.1093/annonc/mds198

  37. Joensuu H, Martin Broto J, Nishida T, Reichardt P, Schöffski P, Maki RG. Followup strategies for patients with gastrointestinal stromal tumour treated with or without adjuvant imatinib after surgery. Eur J Cancer. 2015;51(12):1611-7. DOI: https://doi.org/10.1016/j.ejca.2015.05.009

  38. Fleites Vilma, Soriano JL, Lima M, Morales D, Batista N, Ramón I, et al. Características clínicas y patológicas de pacientes cubanos con tumores del estroma gastrointestinal en etapas no metastásicas. Acta Médica. 2018[acceso:30/8/2020];19(2). Disponible en: http://bvs.sld.cu/revistas/act/vol19_2_18/act04218.htm

  39. Hassanzadeh Rad A, Yousefifard M, Katal S, Asady H, Fard Esfahani A, Moghadas Jafari A, et al. The value of (18)F-fluorodeoxyglucose positron emission tomography for prediction of treatment response in gastrointestinal stromal tumors: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:929-35. DOI: https://doi.org/10.1111/jgh.13247




2020     |     www.medigraphic.com