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Risk of Recurrence – Resectable Disease

Enhanced risk stratification can help to ensure that patients who may benefit from adjuvant therapy for GIST are not excluded.

1 in 2 patients experiences recurrence of GIST following surgery.1

Disease-Specific Survival in Primary GIST1,a
Disease-Specific Survival in Primary GIST
*Based on a subanalysis of patients with primary disease who underwent complete resection(n=80) within a retrospective study of 200 patients with GIST who were treated at a single institution.2


Risk Stratification Criteria

Tumor size, mitotic index, and site are 3 key prognostic features used to assess risk of GIST recurrence and ensure that patients who may benefit from adjuvant therapy are not excluded.3 The National Comprehensive Cancer Network consensus risk stratification, based on 3 large retrospective studies, is as follows:


Current NCCN criteria for risk stratification are based on tumor size, mitotic rate, and site3
Rate of Metastases or Tumor-Related Death in GIST4,a
Tumor Size (cm)
Mitotic Index (HPF)
Gastric
GIST
Jejunal and Ileal GIST
Duodenal
GIST
Rectal
GIST
≤2
>2 ≤ 5
>5 ≤ 10
> 10
≤5 / 50
0%
1.9%
3.6%
12%
0%
4.3%
24%
52%
0%
8.3%
34%b
0%
8.5%
57%b
≤2
>2 ≤ 5
>5 ≤ 10
> 10
>5 / 50
0%b
16%
55%
86%
50%b
73%
85%
90%
N/Ac
50%
86%b
54%
52%
71%b
HPFs, high power fields. Adopted from Miettinen and Lasota, 2006.
  • a Based on previously published long-term follow-up studies on 1055 gastric, 629 small intestinal, 144 duodenal, and 111 rectal GISTs.
  • b Denotes tumor categories with very small numbers of cases. Some data combined, or missing, due to a small number of cases.
  • c No tumors of such category were included in the study. Note that small intestinal and other intestinal GISTs show are markedly worse prognosis in many mitosis and size categories than gastric GISTs
Additional factors to be considered:5
  • Tumor rupture
  • Mucosal invasion
  • Mutational Status
Differences in evaluating mitotic index may have a dramatic impact on risk of progressive disease.4
 

  1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: soft tissue sarcoma. V.2.2008.

  2. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodrull JM, Brennan MF. Two hundred gastrointestinal stromal tumors. Recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51-58.

  3. Demetri GD, Benjamin RS, Blanke CD, et al. NCCN task force report: management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2007;5(suppl 2):S1–S29.

  4. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin. Diagn. Pathol. 2006;23(2):70-83.

  5. Joensuu H. Risk Stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008:39(10); 1411-1419.2008;3:557-586.

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