Gastrointestinal Stromal Tümör Rekürrensinde Risk Faktörleri

Yıl 2021, Cilt: 26 Sayı: 1, 3 - 10, 30.01.2021

Özgür Ekinci , Metin Leblebici , Mehmet Acar Cem Ilgın Erol , Orhan Alimoğlu

https://doi.org/10.21673/anadoluklin.755659

Öz

Amaç: Gastrointestinal stromal tümörler (GIST), gastrointestinal sistemin en yaygın mezenkimal neoplazilerindendir. Temiz sınırlı cerrahi rezeksiyon GIST tedavisinin en önemli basamaklarından birini oluşturmaktadır. Bu araştırmada primer amaç GIST tanısıyla ameliyat ettiğimiz hastalarda rekürrens için risk faktörlerini değerlendirmek, sekonder amaç ise hangi faktölerin sağkalıma etki ettiğini ortaya koymaktır.

Gereç ve Yöntem: Ocak 2013 ile Ağustos 2019 tarihleri arasında kliniğimizde cerrahi olarak tedavi edilen 28 GIST vakasının verileri retrospektif olarak incelendi. Hastalar operasyon öncesi görüntülemeler, histopatolojik ve immünohistokimyasal yönünden incelendi ve hasta bilgileri dokümante edildi.

Bulgular: Hastaların 18’i erkek, 10’u kadındı. Medyan yaş 64,5 idi. (en genç 50, en yaşlı 87). Hastaların 26’sı (%92,9) konvansiyonel, 2’si (%7,1) laparoskopik yöntemle ameliyat edildi. Hastaların 15’inde (%53,6) lezyon midede, 10’ununda (%35,7) jejenum-ileumda, 2’sinde (%7,1) duodenumda, 1’inde (%3,6) ise multifokalda yerleşimliydi. Ortalama tümör çapı 10,1cm idi (En uzun çap 21 cm, en kısa çap 0,5 cm). Hastaların 27’sinde (%96,4) DOG-1, 24’ünde (%85,7) CD117, 23’ünde (%82,1) CD-34, 9’unda (%32,1) SMA, 3’ünde (%10,7) Desmin, 2’sinde (%7,1) S-100 pozitifliği izlenildi. Toplam rekürrens görülen hasta sayısı 5 idi (%17,9). Yapılan istatistiksel analizler sonucunda tümörde nekroz olması, tümörün mide dışında bir organda yerleşmiş olması ve tümör mitoz sayısının yüksek olması rekürrens için anlamlı istatistiksel fark ortaya çıkarmıştır. Ayrıca tümör boyutunun büyük olması rekürrens için anlamlı istatistiksel farklılık ortaya çıkarmıştır. Medyan takip süresi 26 (3-60) ay idi. Yapılan analizlerde tümörde nekroz görülmesi ve tümörün iğsi hücreli tipte olması sağkalımı anlamlı ölçüte kısaltan etkenlerdi.

Sonuç: GIST rekürrensini incelediğimiz bu çalışmada tümör boyutunun büyük olması, tümör nekrozu, mitoz sayısının artmış olması ve tümörün mide dışında bir organda yerleşmiş olması rekürrens için risk faktörü olduğu gözlemlenmiştir. Çalışmanın sekonder amacı olan sağkalım sürelerini etkileyen faktörlerin ise hücre tipi ve tümör nekrozu olduğu görülmüştür.

Anahtar Kelimeler

Gastrointestinalstromal tümör, gastrointestinal sistem, mezenkimal kanser, cerrahi

Risk Factors of Gastrointestinal Stromal Tumor Recurrence

Öz

Aim: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasia of gastrointestinal system. Radical surgery with negative margin is the most important step for treatment of GIST. The primary aim of this study was to evaluate the risk factors for recurrence in patients who underwent surgery with diagnosis of GIST. Secondary aim was to reveal the factors that affect survival.

Materials and Methods: The data of 28 GIST patients who underwent surgery in our clinic between January 2013 and August 2019 were analyzed retrospectively. Patients preoperative radiological images, histopathological and immunohistochemical findings were noted.

Results: Eighteen patients were male, and ten patients were female. Median age was 64.5 (range; 50-87). Twenty-six patients (92.2%) underwent open surgery and 2 patients (7.1%) underwent laparoscopic surgery. Fifteen (53.6%) of the 28 tumors were located in the stomach, 10 (35.7%) in the small intestine, 2 (7.1%) in the duodenum and 1 (3.6%) was located multifocal. Mean tumor diameter was 10.1 cm (range; 0.5-21). The number of patients with recurrence was 5 (17.9%). Tumor with necrosis, tumor located in an organ other than the stomach, and the high number of tumor mitosis revealed a significant difference for recurrence. In addition, large tumor size revealed significant statistical difference for recurrence. The median follow-up period was 26 (3-60) months. Necrosis of tumor and tumor type were the factors that significantly shortened survival.

Conclusion: In this study which we examined the GIST recurrence, it was observed that tumor size, tumor necrosis, increased number of mitosis and tumors located in an organ other than stomach are risk factors for recurrence. In this study which we examined GIST recurrence, tumor size, tumor necrosis, increased number of mitoses and tumors located in an organ other than the stomach are found to be risk factors for recurrence. It was observed that the factors affecting the survival times, which are the secondary aim of the study, were cell type and tumor necrosis.

Anahtar Kelimeler

Gastrointestinal stromal tumor, gastrointestinal system, mesenchymal cancer, surgery

Kaynakça

• Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 2003; 23: 283- 304.
• Domansk HA, Walther CS. Gastrointestinal Stromal Tumor. Monogr Clin Cytol. 2017;22:89-91
• Caterino S, Lorenzon L, Petrucciani N, et al. Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol. 2011;9:13.
• Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 1999; 30: 1213-20
• Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018;24(26):2806‐2817.
• Nishida T, Blay JY, Hirota S, Kitagawa Y, Kang YK. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer. 2016;19(1):3‐14.
• Lim KT, Tan KY. Current research and treatment for gastrointestinal stromal tumors. World J Gastroenterol. 2017;23(27):4856‐4866.
• Landi B, Blay JY, Bonvalot S, et al. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis. 2019;51(9):1223‐1231.
• Eriksson M, Reichardt P, Sundby Hall K, et al. Needle biopsy through the abdominal wall for the diagnosis of gastrointestinal stromal tumour - Does it increase the risk for tumour cell seeding and recurrence?. Eur J Cancer. 2016;59:128‐133.
• Kim GH, Choi KD, Gong CS, et al. Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach: a propensity score-matched case-control study. Gastrointest Endosc. 2020;91(3):527‐536.
• Casali PG, Abecassis N, Aro HT, et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv267.
• Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol. 2012;13(3):265‐274.
• Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33: 459–65.
• DeMatteo RP, Lewis JJ, Leung D, et al: Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg 231:51-58, 2000
• Mengshi Yi, MD,Lin Xia, MD,Yan Zhou, MD, Xiaoting Wu, MD, Wen Zhuang, MD, Yi Chen, MD, Rui Zhao, MD, Qianyi Wan, MD, Liang Du, MD, Yong Zhou, MD. Prognostic value of tumor necrosis in gastrointestinal stromal tumor. Medicine (Baltimore). 2019 Apr; 98(17): e15338
• Segales-Rojas P, Lino-Silva LS, Aguilar-Cruz E, Salcedo-Hernández RA. Association of ki67 Index with Recurrence in Gastrointestinal Stromal Tumors. J Gastrointest Cancer. 2018 Dec;49(4):543-547.
• Atak T, Eren T, Burcu B, Sagiroglu J, Ozemir İA, Alimoglu O. Gastrointestinal Stromal Tumors: Retrospective Analysis of 21 Cases. Haydarpasa Numune Med J 2019;59(2):157–161
• Mazer L, Worth P, Visser B. Minimally invasive options for gastrointestinal stromal tumors of the stomach [published online ahead of print, 2020 Mar 27]. Surg Endosc. 2020;10.1007/s00464-020-07510-x.