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Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome.

Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J - BMC Surg (2015)

Bottom Line: The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively.The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060).No statistically significant difference was found among the three operation types (P = 0.294).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. scyshenchaoyong@163.com.

ABSTRACT

Background: Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. We here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST.

Methods: Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were retrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were calculated using Kaplan-Meier method.

Results: Out of 74 cases, 42 cases were female (56.76%) and 32 cases (43.24%) were male. Approximately 22.97, 47.30, 16.22, and 13.51% of the tumors originated in the first to fourth portion of the duodenum, respectively, with a tumor size of 5.08 ± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00%), abdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76%), and others (n = 7, 9.76%). A total of 18 patients (24.3%) underwent wedge resection (WR); 39 patients (52.7%) underwent segmental resection (SR); and 17 cases (23%) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1-159 months); 19 patients (25.68%) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69%, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively. The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294).

Conclusions: DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.

No MeSH data available.


Related in: MedlinePlus

Recurrence/metastasis-free survival of 74 duodenal GIST patients. a: stratified by surgical procedures (WR, SR vs. PD). b: stratified by tumor size (<5 cm vs. ≥5 cm). c: stratified by mitotic count (≤5, 6–10 vs. > 10). d: stratified by NIH risk classification (low, intermediate vs. high)
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Fig2: Recurrence/metastasis-free survival of 74 duodenal GIST patients. a: stratified by surgical procedures (WR, SR vs. PD). b: stratified by tumor size (<5 cm vs. ≥5 cm). c: stratified by mitotic count (≤5, 6–10 vs. > 10). d: stratified by NIH risk classification (low, intermediate vs. high)

Mentions: With a median follow-up of 56 months (1–159 months), 7 cases were lost to follow-up. A total of 19 patients (25.68 %) had tumor recurrence or metastasis and 1 patient experienced liver and multiple bone metastases (Fig. 1d–f). Fourteen patients (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69 %, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86 %, respectively. The recurrence/metastasis-free survival of the PD group within 5 years was lower than that of the WR group (P = 0.047) but was not significantly different compared with that of the SR group (P = 0.060, as shown in Fig. 2). Moreover, the median recurrence/metastasis-free survival in the PD group (22 months) was shorter than that in the SR group (35 months). However, this difference was not statistically significant (P = 0.064). Notably, the OS among the three surgical procedures was not statistically significant (P = 0.294). The 5-year recurrence/metastasis-free survival rate of patients with tumor size of <5 cm was higher than those with tumor size of ≥5 cm (P < 0.001). The 5-year recurrence/metastasis-free survival rate of patients with mitosis count of ≤5, 6–10, and >10 were 88.5 %, 56.7 % (P = 0.012), and 33.3 % (P = 0.002 for mitotic count ≤ 5, P = 0.346 for mitotic count 6–10), respectively. Patients with low-, intermediate-, and high-risk, the 5-year recurrence/metastasis-free survival rates were 94.7 %, 57.1 % (P = 0.025), and 53.1 % (P = 0.001 for low risk and P = 0.364 for intermediate risk), respectively. Patients with intermediate- or high-risk who took IM adjuvant therapy revealed a trend of higher recurrence/metastasis-free survival than that of patients without taking IM (P = 0.326).Fig. 2


Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome.

Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J - BMC Surg (2015)

Recurrence/metastasis-free survival of 74 duodenal GIST patients. a: stratified by surgical procedures (WR, SR vs. PD). b: stratified by tumor size (<5 cm vs. ≥5 cm). c: stratified by mitotic count (≤5, 6–10 vs. > 10). d: stratified by NIH risk classification (low, intermediate vs. high)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536755&req=5

Fig2: Recurrence/metastasis-free survival of 74 duodenal GIST patients. a: stratified by surgical procedures (WR, SR vs. PD). b: stratified by tumor size (<5 cm vs. ≥5 cm). c: stratified by mitotic count (≤5, 6–10 vs. > 10). d: stratified by NIH risk classification (low, intermediate vs. high)
Mentions: With a median follow-up of 56 months (1–159 months), 7 cases were lost to follow-up. A total of 19 patients (25.68 %) had tumor recurrence or metastasis and 1 patient experienced liver and multiple bone metastases (Fig. 1d–f). Fourteen patients (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69 %, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86 %, respectively. The recurrence/metastasis-free survival of the PD group within 5 years was lower than that of the WR group (P = 0.047) but was not significantly different compared with that of the SR group (P = 0.060, as shown in Fig. 2). Moreover, the median recurrence/metastasis-free survival in the PD group (22 months) was shorter than that in the SR group (35 months). However, this difference was not statistically significant (P = 0.064). Notably, the OS among the three surgical procedures was not statistically significant (P = 0.294). The 5-year recurrence/metastasis-free survival rate of patients with tumor size of <5 cm was higher than those with tumor size of ≥5 cm (P < 0.001). The 5-year recurrence/metastasis-free survival rate of patients with mitosis count of ≤5, 6–10, and >10 were 88.5 %, 56.7 % (P = 0.012), and 33.3 % (P = 0.002 for mitotic count ≤ 5, P = 0.346 for mitotic count 6–10), respectively. Patients with low-, intermediate-, and high-risk, the 5-year recurrence/metastasis-free survival rates were 94.7 %, 57.1 % (P = 0.025), and 53.1 % (P = 0.001 for low risk and P = 0.364 for intermediate risk), respectively. Patients with intermediate- or high-risk who took IM adjuvant therapy revealed a trend of higher recurrence/metastasis-free survival than that of patients without taking IM (P = 0.326).Fig. 2

Bottom Line: The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively.The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060).No statistically significant difference was found among the three operation types (P = 0.294).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. scyshenchaoyong@163.com.

ABSTRACT

Background: Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. We here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST.

Methods: Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were retrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were calculated using Kaplan-Meier method.

Results: Out of 74 cases, 42 cases were female (56.76%) and 32 cases (43.24%) were male. Approximately 22.97, 47.30, 16.22, and 13.51% of the tumors originated in the first to fourth portion of the duodenum, respectively, with a tumor size of 5.08 ± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00%), abdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76%), and others (n = 7, 9.76%). A total of 18 patients (24.3%) underwent wedge resection (WR); 39 patients (52.7%) underwent segmental resection (SR); and 17 cases (23%) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1-159 months); 19 patients (25.68%) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69%, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively. The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294).

Conclusions: DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.

No MeSH data available.


Related in: MedlinePlus