Valutazione di fattori prognostici nel trattamento integrato dei GIST
Articolo, 138 - 142Tag this article
Gastrointestinal stromal tumors (GIST) are mesenchymal tumorssupposed to arise from the cells of Cajal for mutations of the tyrosine re-ceptor kinases c-kit or platelet-derived growth factor receptor A. Ima-tinib selectively inhibits the kinase activity. Surgical treatments includ-ing radical resection and local excision remain the main treatment forprimary gastrointestinal stromal tumors (GISTs). Patients with high-grade GISTs have a higher risk of tumor recurrence and a shorter lifeexpectancy the introduction of Imatinib had changed drammaticallythe natural history of that kind of tunors, expecially in non-resectabletumors. AIM: we try to find the relationship between the tumor chara-teristics (size,mitosis, risk group, clinical sign and symptoms) and theoutcome (disease free survival and overall survival). Methods: from2001 to 2007, 20 patients (11 m/9 f) median age 68.9 (range 50-83yrs) underwent surgery for GIST resection, occasional diagnosys wasperformed in 3 patients. 15 were primary GIST, 2 recurrence localizedin ileum. Was performed 9 wedge gastric resections, 1 gastric resection,11 ileal resection. Main tumor size was 7.1 cm +/- 5, tumor necrosiswas found in 2 cases. After a median follow-up of 55.3 months (39.4-71.2) We stratify the patiens in risk group and we observed a statisticrelatrionship between tumor size and mitosis ane DFS and OS. Con-clusion: even in a small group surgical excision of low- and intermedi-ate-grade GIST has an excellent prognosis. Surgery remains the main-stay of treatments, and high-grade tumours carry a significantly worseprognosis. High mitotic rates and size are important poor prognostica-tor.
KEY WORDS: GIST, surgery, risk factors.