Gastrointestinal stromal tumors (GISTs), 10-year experience: Patterns of failure and prognostic factors for survival of 127 patients

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) and are believed to originate from the interstitial cell of Cajal. Management of GIST has evolved very rapidly in the last decade. Aim: To report our surgical experience in the treatment of GIST patients, to evaluate the prognostic factors and to discuss some controversial issues about the role of target therapy. Patients and methods: One hundred and twenty seven consecutive patients who underwent surgical resection for GISTs at Nasser Institute (98 patients) and NCI, Cairo University (29 patients) from January 2000 to December 2009 were reviewed retrospectively. The clinical and pathological features of patients were collected. Also data about treatment variables, patterns of failure and factors that predict survival were collected and analyzed. Results: Of the 127 patients, 81 (64%) had primary disease without metastasis, 11 (9%) had metastatic lesions at presentation, and 35 (27%) presented with recurrence (isolated, metastasis or both). Patients with primary disease underwent complete resection of gross disease. The 5-year overall survival was 53.4% and disease free survival (DFS) was 46.5%. The median DFS was 43.0 months (95% Cl: 21.2-64.9). On multivariate analysis, survival was affected by mode of presentation, gastric origin and tumor size. Failures after resection were predominantly intraabdominal (original site, peritoneal, and liver), and rarely lungs. Conclusion: Surgical resection is the mainstay of treatment of GIST. Tumor size and gastric origin were the predicators for DFS in patients presenting with primary disease