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Re-appraisal of risk classifications for primary gastrointestinal stromal tumors (GISTs) after complete resection: indications for adjuvant therapy

Byline: Yoshitomo Yanagimoto (1), Tsuyoshi Takahashi (2), Kazuya Muguruma (3), Takahiro Toyokawa (4), Hiroshi Kusanagi (5), Takeshi Omori (1), Toru Masuzawa (1), Koji Tanaka (1), Seiichi Hirota (6), Toshirou Nishida (1,7) Keywords: Gastrointestinal stromal tumor; Risk stratification; Adjuvant therap... Full description

Journal Title: Gastric Cancer 2015, Vol.18(2), pp.426-433
Main Author: Yanagimoto, Yoshitomo
Other Authors: Takahashi, Tsuyoshi , Muguruma, Kazuya , Toyokawa, Takahiro , Kusanagi, Hiroshi , Omori, Takeshi , Masuzawa, Toru , Tanaka, Koji , Hirota, Seiichi , Nishida, Toshirou
Format: Electronic Article Electronic Article
Language: English
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ID: ISSN: 1436-3291 ; E-ISSN: 1436-3305 ; DOI: 10.1007/s10120-014-0386-7
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recordid: springer_jour10.1007/s10120-014-0386-7
title: Re-appraisal of risk classifications for primary gastrointestinal stromal tumors (GISTs) after complete resection: indications for adjuvant therapy
format: Article
creator:
  • Yanagimoto, Yoshitomo
  • Takahashi, Tsuyoshi
  • Muguruma, Kazuya
  • Toyokawa, Takahiro
  • Kusanagi, Hiroshi
  • Omori, Takeshi
  • Masuzawa, Toru
  • Tanaka, Koji
  • Hirota, Seiichi
  • Nishida, Toshirou
subjects:
  • Gastrointestinal stromal tumor
  • Risk stratification
  • Adjuvant therapy
  • Recurrence
  • Prognosis
ispartof: Gastric Cancer, 2015, Vol.18(2), pp.426-433
description: Byline: Yoshitomo Yanagimoto (1), Tsuyoshi Takahashi (2), Kazuya Muguruma (3), Takahiro Toyokawa (4), Hiroshi Kusanagi (5), Takeshi Omori (1), Toru Masuzawa (1), Koji Tanaka (1), Seiichi Hirota (6), Toshirou Nishida (1,7) Keywords: Gastrointestinal stromal tumor; Risk stratification; Adjuvant therapy; Recurrence; Prognosis Abstract: Background A substantial number of localized gastrointestinal stromal tumor (GIST) patients have recurrences even after complete resection. The risk of recurrence after complete resection should be estimated when considering adjuvant therapy. In this study, we evaluated prognostic factors of GIST recurrence and compared several reported risk-stratification schemes for defining risk of recurrence to guide the use of adjuvant therapy using data from a large Japanese GIST population. Methods We analyzed clinicopathological data collected retrospectively and prospectively from 712 GISTs with complete resection from 1980--2010. We evaluated possible prognostic factors and compared the National Institutes of Health consensus criteria, the Armed Forces Institute of Pathology criteria, Joensuu's modified NIH classification (J-NIHC), the American Joint Committee on Cancer staging system (AJCCS), and the Japanese modified NIH criteria for prediction of tumor recurrence in adjuvant settings. Results Univariate analysis suggested that the following factors were prognostic: tumor size, mitotic count, site, clinically malignant features of rupture and/or invasion, and gender. In multivariate analysis, size >5 cm, mitotic count >5/50 HPF, non-gastric location, and the presence of rupture and/or macroscopic invasion were independent adverse prognostic factors. When adjuvant therapy is considered for patients with high-risk GIST, the J-NIHC was the most sensitive classification system, while the AJCCS appeared to be the most accurate for predicting recurrence. Conclusion Tumor size, mitotic count, tumor site, and clinical features of rupture and/or invasion were important prognostic factors for GIST recurrence. Joensuu's classification appeared to best identify candidates for adjuvant therapy. Author Affiliation: (1) Department of Surgery, Osaka Police Hospital, Kitayama-cho 10-31, Tennouji-ku, Osaka, 543-0035, Japan (2) Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (3) Department of Oncological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan (4) Department of Gastroenterological Surg
language: eng
source:
identifier: ISSN: 1436-3291 ; E-ISSN: 1436-3305 ; DOI: 10.1007/s10120-014-0386-7
fulltext: fulltext_linktorsrc
issn:
  • 1436-3305
  • 14363305
  • 1436-3291
  • 14363291
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titleRe-appraisal of risk classifications for primary gastrointestinal stromal tumors (GISTs) after complete resection: indications for adjuvant therapy
creatorYanagimoto, Yoshitomo ; Takahashi, Tsuyoshi ; Muguruma, Kazuya ; Toyokawa, Takahiro ; Kusanagi, Hiroshi ; Omori, Takeshi ; Masuzawa, Toru ; Tanaka, Koji ; Hirota, Seiichi ; Nishida, Toshirou
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descriptionByline: Yoshitomo Yanagimoto (1), Tsuyoshi Takahashi (2), Kazuya Muguruma (3), Takahiro Toyokawa (4), Hiroshi Kusanagi (5), Takeshi Omori (1), Toru Masuzawa (1), Koji Tanaka (1), Seiichi Hirota (6), Toshirou Nishida (1,7) Keywords: Gastrointestinal stromal tumor; Risk stratification; Adjuvant therapy; Recurrence; Prognosis Abstract: Background A substantial number of localized gastrointestinal stromal tumor (GIST) patients have recurrences even after complete resection. The risk of recurrence after complete resection should be estimated when considering adjuvant therapy. In this study, we evaluated prognostic factors of GIST recurrence and compared several reported risk-stratification schemes for defining risk of recurrence to guide the use of adjuvant therapy using data from a large Japanese GIST population. Methods We analyzed clinicopathological data collected retrospectively and prospectively from 712 GISTs with complete resection from 1980--2010. We evaluated possible prognostic factors and compared the National Institutes of Health consensus criteria, the Armed Forces Institute of Pathology criteria, Joensuu's modified NIH classification (J-NIHC), the American Joint Committee on Cancer staging system (AJCCS), and the Japanese modified NIH criteria for prediction of tumor recurrence in adjuvant settings. Results Univariate analysis suggested that the following factors were prognostic: tumor size, mitotic count, site, clinically malignant features of rupture and/or invasion, and gender. In multivariate analysis, size >5 cm, mitotic count >5/50 HPF, non-gastric location, and the presence of rupture and/or macroscopic invasion were independent adverse prognostic factors. When adjuvant therapy is considered for patients with high-risk GIST, the J-NIHC was the most sensitive classification system, while the AJCCS appeared to be the most accurate for predicting recurrence. Conclusion Tumor size, mitotic count, tumor site, and clinical features of rupture and/or invasion were important prognostic factors for GIST recurrence. Joensuu's classification appeared to best identify candidates for adjuvant therapy. Author Affiliation: (1) Department of Surgery, Osaka Police Hospital, Kitayama-cho 10-31, Tennouji-ku, Osaka, 543-0035, Japan (2) Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan (3) Department of Oncological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan (4) Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan (5) Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan (6) Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan (7) Department of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan Article History: Registration Date: 02/05/2014 Received Date: 03/02/2014 Accepted Date: 23/04/2014 Online Date: 23/05/2014 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s10120-014-0386-7) contains supplementary material, which is available to authorized users.
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