Outcome and prognostic factors of primary gastrointestinal stromal tumours following complete surgical resection


  • Mohamed Ebrahim El Dahshan Department of Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
  • Mohamed Ali Mless Department of Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
  • Nehal Mohamed Elmashad Department of Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
  • Hossam Ramadan Moussa Department of Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
  • Ahmed Atia Darwish Department of Surgery, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt




Outcome, Prognostic factors, Gastrointestinal stromal tumours, Resection


Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. Surgical excision is the definitive treatment for primary localized GISTs. Targeted therapy represented by tyrosine kinase inhibitors has clearly improved the survival rates in patients with GISTs. The aim of this study was to identify prognostic factors influencing tumor recurrence and survival after curative resection of primary GISTs.

Methods: This study was conducted on thirty seven patients with localized primary GIST who were operated on in the Department of General Surgery. Then completed adjuvant therapy in the medical Oncology Department, Faculty of Medicine; Tanta University Hospital, from March 2016 to August 2017. All patients’ data, clinical presentations, radiological and endoscopic data, surgical procedures, complications, and survival data were collected, reviewed and analyzed.

Results: The mean age of the studied cases was 53.62 years. 14 patients were males and 23 patients were females. Eleven patients had performance status 2. Abdominal pain was the most common complaint. 4 patients presented with acute intestinal obstruction. Ileum was the most common site (14 cases) followed by stomach (13 cases). We reported four cases of extra-gastrointestinal stromal tumors (EGISTs). According to the mitotic index in studied cases; sixteen patients had mitotic count ˃5/50 HPF. Surgical excision was done in all cases with histopathologically negative resection margins. Thirty three cases showed good complete response without local recurrence or distant metastasis.

Conclusions:Performance status of patients, tumor size and mitotic index were independent prognostic predictors for tumor recurrence or metastasis.



Chandrasekhara V, Ginsberg GG. Endoscopic management of gastrointestinal stromal tumors. Curr Gastroenterol Rep. 2011;13:532-9.

Sircar K, Hewlett BR, Huizinga JD, Chorneyko K, Berezin I, Riddell RH. Interstitial cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol. 1999;23(4):377-89.

Rammohan A, Sathyanesan J, Rajendran K, Pitchaimuthu A, Perumal SK, Srinivasan U, et al. Gist of gastrointestinal stromal tumors: a review. World J Gastrointest Oncol. 2013;5:102-12.

Sepe PS Brugge WR. A guide for the diagnosis and management of gastrointestinal stromal cell tumors. Nat Rev Gastroenterol Hepatol. 2009;6:363-71.

Paral J, Slaninka I, Kalabova H, hadzi-Nikolov D. Gastrointestinal stromal tumors: Review on morphology, molecular pathology, diagnositics, prognosis and treatment options. Acta Gastroenterol Belg. 2010;73:349-59.

Agaram NP, Laquaglia MP, Ustun B, Guo T, Wong GC, Socci ND, et al. Molecular characterization of pediatric gastrointestinal stromal tumors. Clin Cancer Res. 2008;14:3204.

Van Den Abbeele AD. The lessons of GIST-PET and PET/CT: a new paradigm for imaging. Oncologist. 2008;13(Suppl 2):8-13.

European Sarcoma Network Working Group. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol ESMO. 2014;25(Suppl 3):iii21-26.

Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J National Comprehensive Cancer Network: JNCCN, 2007;5(Suppl 2):S1-29.

DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000;231:51.

Huang RX, Xiang P, Huang C. Gastrointestinal stromal tumors: current translational research and management modalities. Eur Rev Med Pharmacol Sci. 2014;18:3076-85.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55.

McCarter MD, Antonescu CR, Ballman KV, Maki RG, Pisters PW, Demetri GD, et al. Intergroup Adjuvant Gist Study Team. Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg. 2012;215:53-9.

Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schütte J, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307:1265-72.

Kramer K, Knippschild U, Mayer B, Bögelspacher K, Spatz H, Henne-Bruns D, et al. Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST). BMC Cancer. 2015;15:57.

Prasertcharoensuk S, Thanapongpornthana P, Bhudhisawasdi V, Pugkhem A, Jenwitheesuk K, Sookprasert A, et al. Prognostic Factors for Large Symptomatic Gists: a Pragmatic Study of Experiences From a University Hospital Over 10 Years. Asian Pacific J Cancer Prevent. 2017;18:655-8.

Sorour MA, Kassem MI, Ghazal AEHA. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg. 2014;12(4):269-80.

Morrison JE, Hodgdon IA. Laparoscopic Management of Obstructing Small Bowel GIST Tumor. JSLS. 2013;17:645-50.

Pirşcoveanu M, Munteanu M, Mănescu P, Ruxanda A, Vasile L, Dina S, et al. Gastrointestinal stromal tumor in the cecum--a rare cause of ileo-cecal-colic invagination. Chirurgia (Bucur). 2010;105(3):403-7.

Fersahoglu MM, Fersahoglu AT, Bulut NE, Narin BSA, Tezer S. An infrequent case of intussusception caused by gastrointestinal stromal tumor in an adult patient, North Clin Istanb. 2017;4(2):192-4.

Giestas S, Almeida N, Martins R, Canhoto A, Oliveira P, Figueiredo P, et al. Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding, GE Port J Gastroenterol. 2016;23(5):279-81.

Jameel ARA, Segamalai D, Murugaiyan G, Shanmugasundaram R, Obla NB. Gastroduodenal Intussusception due to Gastrointestinal Stromal Tumour (GIST) J Clin Diagn Res. 2017;11(8):PD09-10.

Zhou Y, Wu XD, Shi Q. Gastroduodenal intussusception and pylorus obstruction induced by a c-KIT-negative gastric gastrointestinal stromal tumor: case report and review of the literature. Z Gastroenterol. 2018;18:203-23.

Yin Z, Gao J, Liu W, Huang C. Clinicopathological and Prognostic Analysis of Primary Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding: a 10-Year Retrospective Study, J Gastrointest Surg. 2017;21:792-800.

Du CY, Shi YQ, Zhou Y, Fu H, Zhao G. The analysis of status and clinical implication of KIT and PDGFRA mutations in gastrointestinal stromal tumor (GIST). J Surg Oncol. 2008;98:175-8.

Cho MY, Sohn JH, Kim JM, Kim KM, Park YS, Kim WH, et al. Current trends in the epidemiological and pathological characteristics of gastrointestinal stromal tumors in Korea, 2003-2004. J Korean Med Sci. 2010;25:853-62.

Corless CL, Ballman KV, Antonescu CR, Kolesnikova V, Maki RG, Pisters PW, et al. Pathologic and Molecular Features Correlate With Long-Term Outcome After Adjuvant Therapy of Resected Primary GI Stromal Tumor: The ACOSOG Z9001 Trial. J Clin Oncol. 2014;32:1563-70.

Mandrioli M, Mastrangelo L, Masetti M, Zanini N, Lega S, Nannini M, et al. Characterization of malignant gastrointestinal stromal tumors—a single center experience. J Gastrointest Oncol. 2017;8(6):1037-45.

McDonnell MJ, Punnoose S, Viswanath YKS. Gastrointestinal stromal tumours (GISTs): an insight into clinical practice with review of literature. Frontline Gastroenterol. 2017;8:19-25.

Liu X, Qiu H, Zhang P, Feng X, Chen T, Li Y, et al. On behalf of China Gastrointestinal Stromal Tumor Study Group (CN-GIST);Prognostic role of tumor necrosis in patients undergoing curative resection for gastric gastrointestinal stromal tumor: a multicenter analysis of 740 cases in China. Cancer Med. 2017;6(12):2796-803.

Bai YK, Shao YF, Cao WL, Shi SS, Yu LW. Analysis of prognostic and clinicopathologic factors in gastrointestinal stromal tumors of the stomach. Zhonghua Wei Chang Wai Ke Za Zhi. 2007;10(1):21-5.

Hou YY, Lu SH, Zhou Y. Predictive values of clinical and pathological parameters for malignancy of gastrointestinal stromal tumors. Histol Histopathol. 2009;24(6):737-47.

Park CH, Kim GH, Lee BE, Song GA, Park DY, Choi KU, et al. Two staging systems for gastrointestinal stromal tumors in the stomach: which is better?. BMC Gastroenterol. 2017;17:141.






Original Research Articles