In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 4_suppl ( 2016-02-01), p. 96-96
Abstract:
96 Background: Ruptured GIST, either preoperatively or intraoperatively, has ominous prognosis and is classified as high risk GIST in the modified Fletcher risk stratification. Although patients (pts) with these GISTs are recommended for 3-year imatinib adjuvant therapy, their clinicopathological features and compliance of guidelines are unknown. Methods: Between Dec. 2012 and Aug. 2015, 474 pts with high-risk GISTs locally diagnosed were prospectively registered. Among them, 453 pts with GISTs histologically confirmed by central review were analyzed. There were 243 males and 210 females with median age of 65 yrs. In the central review, H & E, immunohistochemistry, and genotyping were tested. Results: Disease was located in the stomach (n = 279), small intestine (n = 137), large intestine (n = 25), or others (n = 12). Median tumor size was 7.7 cm and median mitosis (local pathology) was 10/50HPF. Tumor rupture was seen in 54 pts (12%) who had preoperative rupture (28 pts) or intraoperative rupture (25 pts). After surgery, adjuvant therapy was administered for 342 pts (75%) and withheld for 89 pts (20%). Tumor rupture was frequently observed in small intestinal GIST (23.6%) other than the duodenum and in epithelioid and/or mixed features (24%). Mitosis of ruptured GIST (median = 5.0/50 HPF) was significantly lower than that of non-ruptured (11/50 HPF). Age, gender, tumor size and genotype are not related with rupture. There was no difference in postoperative complications and adhibition of adjuvant therapy in pts who have ruptures vs pts who don’t. Preoperative rupture was associated with small intestinal GIST and R1 surgery. Mitosis was significantly lower in GIST with preoperative rupture (5/50 HPF) than that without rupture (11/50 HPF). GIST with intraoperative rupture (11.8 cm) was larger than that without rupture (7.5 cm) although there was no difference in mitosis, location and genotype. Frequency of intraoperative rupture was not different between laparoscopic surgery (4.8%) and open one (6.3%). Conclusions: Tumor rupture was not infrequent in high risk GIST and half of rupture was occurred during surgery, which may be related to large tumor size but not with laparoscopic surgery. Clinical trial information: UMIN000009531.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2016.34.4_suppl.96
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2016
detail.hit.zdb_id:
2005181-5
