RSS-Feed abonnieren

DOI: 10.1055/s-0041-1740297
Prognostic Factors and Management of Colorectal Gastrointestinal Stromal Tumors

Abstract
Introduction The gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Even though it can be found in any location of the digestive tract, the colorectal GIST is rare. With this study, we aim to review the current knowledge regarding the prognosis and management of colorectal GIST.
Methods A literature search was conducted in PubMed, and 717 articles were collected. After analyzing these studies, 60 articles were selected to use in this review.
Results The mitotic index, as well as tumor size and location were identified as good discriminators of prognosis in various studies. Surgery remains the only curative therapy for potentially resectable tumors. However, even after surgical resection, some patients develop disease recurrence and metastasis, especially those with high-risk tumors. Therefore, surgical resection alone might be inadequate for the management of all colorectal GISTs. The discovery of GIST's molecular pathway led to a shift in its therapy, insofar as tyrosine kinase inhibitors became part of the treatment schemes for this tumor, revolutionizing the treatment's outcome and prognosis.
Discussion/Conclusion The controversy concerning colorectal GIST prognosis and treatment can be, in part, attributed to the limited number of studies in the literature. In this review, we gathered the most recent knowledge about the prognosis and management of GIST in this rare location and propose two algorithms for its approach. Lastly, we highlight the importance of an individualized approach in the setting of a multidisciplinary team.
Sources of Support of Study Development
None
Publikationsverlauf
Eingereicht: 25. März 2021
Angenommen: 06. August 2021
Artikel online veröffentlicht:
31. Januar 2022
© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Nishida T, Goto O, Raut CP, Yahagi N. Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 2016; 122 (20) 3110-3118
- 2 Gaitanidis A, El Lakis M, Alevizakos M, Tsaroucha A, Pitiakoudis M. Predictors of lymph node metastasis in patients with gastrointestinal stromal tumors (GISTs). Langenbecks Arch Surg 2018; 403 (05) 599-606
- 3 Porter MG, Stoeger SM. Atypical Colorectal Neoplasms. Surg Clin North Am 2017; 97 (03) 641-656
- 4 Cavnar MJ, Wang L, Balachandran VP. et al. Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome. Ann Surg Oncol 2017; 24 (13) 3972-3980
- 5 Feng F, Tian Y, Liu Z. et al. Clinicopathological features and prognosis of colonic gastrointestinal stromal tumors: evaluation of a pooled case series. Oncotarget 2016; 7 (26) 40735-40745
- 6 Li Y, Meng X. The efficacy of adjuvant imatinib therapy in improving the prognosis of patients with colorectal gastrointestinal stromal tumours. Ann R Coll Surg Engl 2015; 97 (03) 215-220
- 7 Kang W, Zhu C, Yu J, Ye X, Ma Z. KIT gene mutations in gastrointestinal stromal tumor. Front Biosci 2015; 20: 919-926
- 8 Sakin A, Can O, Arici S. et al. Factors Affecting Disease-Free Survival in Operated Nonmetastatic Gastrointestinal Stromal Tumors. J Surg Res 2019; 241: 170-177
- 9 Wilkinson MJ, Fitzgerald JE, Strauss DC. et al. Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib. Br J Surg 2015; 102 (08) 965-971
- 10 Liu X, Qiu H, Zhang P. et al; China Gastrointestinal Stromal Tumor Study Group (CN-GIST). Prognostic factors of primary gastrointestinal stromal tumors: a cohort study based on high-volume centers. Chin J Cancer Res 2018; 30 (01) 61-71
- 11 Kelley KA, Byrne R, Lu KC. Gastrointestinal Stromal Tumors of the Distal Gastrointestinal Tract. Clin Colon Rectal Surg 2018; 31 (05) 295-300
- 12 Blay JY, Shen L, Kang YK. et al. Nilotinib versus imatinib as first-line therapy for patients with unresectable or metastatic gastrointestinal stromal tumours (ENESTg1): a randomised phase 3 trial. Lancet Oncol 2015; 16 (05) 550-560
- 13 Li R, Song S, He X. et al. Relationship Between Fibrinogen to Albumin Ratio and Prognosis of Gastrointestinal Stromal Tumors: A Retrospective Cohort Study. Cancer Manag Res 2020; 12: 8643-8651
- 14 Hatipoğlu E, Demiryas S. Gastrointestinal stromal tumors: 16 years' experience within a university hospital. Rev Esp Enferm Dig 2018; 110 (06) 358-364
- 15 Qi J, Liu HL, Ren F. et al. Preoperative adjuvant therapy for locally advanced and recurrent/metastatic gastrointestinal stromal tumors: a retrospective study. World J Surg Oncol 2020; 18 (01) 70
- 16 Han X, Xu J, Qiu H, Lin G. A Novel Curative Treatment Strategy for Patients with Lower Grade Rectal Gastrointestinal Stromal Tumor: Chemoreduction Combined with Transanal Endoscopic Microsurgery. J Laparoendosc Adv Surg Tech A 2017; 27 (06) 579-585
- 17 Almaazmi H, Stem M, Lo BD. et al. The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors. J Gastrointest Surg 2020; 24 (01) 98-108
- 18 Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006; 23 (02) 70-83
- 19 Theodoropoulos DG. Gastrointestinal tumors of the colon and rectum. Clin Colon Rectal Surg 2011; 24 (03) 161-170
- 20 Wu X, Li J, Xu W, Gao J, Li Y, Shen L. Postoperative imatinib in patients with intermediate risk gastrointestinal stromal tumor. Future Oncol 2018; 14 (17) 1721-1729
- 21 Liu Z, Sun Y, Li Y. et al. Colonic Gastrointestinal Stromal Tumor: A Population-Based Analysis of Incidence and Survival. Gastroenterol Res Pract 2019; 2019: 3849850
- 22 Kukar M, Kapil A, Papenfuss W, Groman A, Grobmyer SR, Hochwald SN. Gastrointestinal stromal tumors (GISTs) at uncommon locations: a large population based analysis. J Surg Oncol 2015; 111 (06) 696-701
- 23 Tsai MC, Lin JW, Lin SE, Chen HH, Lee CM, Hu TH. Prognostic analysis of rectal stromal tumors by reference of National Institutes of Health risk categories and immunohistochemical studies. Dis Colon Rectum 2008; 51 (10) 1535-1543
- 24 Stuart E, Banerjee S, de la Torre J. et al. Frequent rectal gastrointestinal stromal tumor recurrences in the imatinib era: Retrospective analysis of an International Patient Registry. J Surg Oncol 2019; 120 (04) 715-721
- 25 Shu P, Sun XF, Fang Y. et al. Clinical outcomes of different therapeutic modalities for rectal gastrointestinal stromal tumor: Summary of 14-year clinical experience in a single center. Int J Surg 2020; 77: 1-7
- 26 Hu TH, Tai MH, Chuah SK. et al. Elevated p21 expression is associated with poor prognosis of rectal stromal tumors after resection. J Surg Oncol 2008; 98 (02) 117-123
- 27 Basilio-de-Oliveira RP, Pannain VL. Prognostic angiogenic markers (endoglin, VEGF, CD31) and tumor cell proliferation (Ki67) for gastrointestinal stromal tumors. World J Gastroenterol 2015; 21 (22) 6924-6930
- 28 Hu TH, Lin JW, Chen HH, Liu LF, Chuah SK, Tai MH. The expression and prognostic role of hepatoma-derived growth factor in colorectal stromal tumors. Dis Colon Rectum 2009; 52 (02) 319-326
- 29 Stotz M, Liegl-Atzwanger B, Posch F. et al. Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection. PLoS One 2016; 11 (07) e0159448
- 30 Li HL, Wang LH, Hu YL. et al. Clinical and prognostic significance of CC chemokine receptor type 8 protein expression in gastrointestinal stromal tumors. World J Gastroenterol 2020; 26 (31) 4656-4668
- 31 Sun J, Mei Y, Zhu Q. et al. Relationship of prognostic nutritional index with prognosis of gastrointestinal stromal tumors. J Cancer 2019; 10 (12) 2679-2686
- 32 IJzerman NS, Mohammadi M, Tzanis D. et al. Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort. Eur J Surg Oncol 2020; 46 (06) 1124-1130
- 33 Hawkins AT, Wells KO, Krishnamurty DM. et al. Preoperative Chemotherapy and Survival for Large Anorectal Gastrointestinal Stromal Tumors: A National Analysis of 333 Cases. Ann Surg Oncol 2017; 24 (05) 1195-1201
- 34 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 (03) 265-274
- 35 Xiao CC, Zhang S, Wang MH. et al. Clinicopathological features and prognostic factors of rectal gastrointestinal stromal tumors. J Gastrointest Surg 2013; 17 (04) 793-798
- 36 Wang SY, Wu CE, Lai CC. et al. Prospective Evaluation of Neoadjuvant Imatinib Use in Locally Advanced Gastrointestinal Stromal Tumors: Emphasis on the Optimal Duration of Neoadjuvant Imatinib Use, Safety, and Oncological Outcome. Cancers (Basel) 2019; 11 (03) E424
- 37 Amato A. Colorectal gastrointestinal stromal tumor. Tech Coloproctol 2010; 14 (Suppl. 01) S91-S95
- 38 Yasui M, Tsujinaka T, Mori M, Takahashi T, Nakashima Y, Nishida T. Kinki GIST Study Group. Characteristics and prognosis of rectal gastrointestinal stromal tumors: an analysis of registry data. Surg Today 2017; 47 (10) 1188-1194
- 39 Guo W, Yang Z, Wei Y. et al. Radical excision versus local resection for primary rectal gastrointestinal stromal tumors. Cohort Study. Int J Surg 2020; 77: 190-197
- 40 Li C, Su D, Xie C, Chen Q, Zhou J, Wu X. Lymphadenectomy is associated with poor survival in patients with gastrointestinal stromal tumors. Ann Transl Med 2019; 7 (20) 558
- 41 Jakob J, Mussi C, Ronellenfitsch U. et al. Gastrointestinal stromal tumor of the rectum: results of surgical and multimodality therapy in the era of imatinib. Ann Surg Oncol 2013; 20 (02) 586-592
- 42 Kaneko M, Emoto S, Murono K. et al. Neoadjuvant imatinib therapy in rectal gastrointestinal stromal tumors. Surg Today 2019; 49 (06) 460-466
- 43 Kaneko M, Nozawa H, Emoto S. et al. Neoadjuvant Imatinib Therapy Followed by Intersphincteric Resection for Low Rectal Gastrointestinal Stromal Tumors. Anticancer Res 2017; 37 (09) 5155-5160
- 44 Yang Z, Guo W, Huang R, Hu M, Wang H, Wang H. Transanal versus nontransanal surgery for the treatment of primary rectal gastrointestinal stromal tumors: a 10-year experience in a high-volume center. Ann Transl Med 2020; 8 (05) 201
- 45 Liu H, Yan Z, Liao G, Yin H. Treatment strategy of rectal gastrointestinal stromal tumor (GIST). J Surg Oncol 2014; 109 (07) 708-713
- 46 Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg 2009; 96 (06) 567-578
- 47 Tang S, Yin Y, Shen C. et al. Preoperative imatinib mesylate (IM) for huge gastrointestinal stromal tumors (GIST). World J Surg Oncol 2017; 15 (01) 79
- 48 Casali PG. Aea. Gastrointestinal Stromal Tumours N. ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Guideline. Ann Oncol 2018; 29 (04) 68-78
- 49 National Comprehensive Cancer NetworK. von Mehren M KJ. et al. NCCN Clinical Practice Guidelines in Oncology: Gastrointestinal Stromal Tumors (GISTs) Version 1.2021. Accessed January 16, 2021, https://www.nccn.org/professionals/physician_gls/default.aspx
- 50 Zanwar S, Ostwal V, Sahu A. et al. Rectal GIST-Outcomes and viewpoint from a tertiary cancer center. Indian J Gastroenterol 2016; 35 (06) 445-449
- 51 Lee JC, Chen CH, Chen TC, Yeh CN, Yeh TS. Preoperative tyrosine kinase inhibitors risks bowel anastomotic healing in patients with advanced primary and recurrent/metastatic gastrointestinal stromal tumors— A rose has its thorns. Eur J Surg Oncol 2019; 45 (02) 153-159
- 52 Dematteo RP, Ballman KV, Antonescu CR. et al; American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009; 373 (9669): 1097-1104
- 53 Jakob J, Hohenberger P. Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors. Visc Med 2018; 34 (05) 359-365
- 54 Joensuu H, Eriksson M, Sundby Hall K. et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA 2012; 307 (12) 1265-1272
- 55 Zhang Z, Jiang T, Wang W, Piao D. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumor after failure with imatinib and sunitinib treatment: A meta-analysis. Medicine (Baltimore) 2017; 96 (48) e8698
- 56 Grothey A, Blay JY, Pavlakis N, Yoshino T, Bruix J. Evolving role of regorafenib for the treatment of advanced cancers. Cancer Treat Rev 2020; 86: 101993
- 57 Demetri GD, Reichardt P, Kang YK. et al; GRID study investigators. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381 (9863): 295-302
- 58 Keung EZ, Fairweather M, Raut CP. The Role of Surgery in Metastatic Gastrointestinal Stromal Tumors. Curr Treat Options Oncol 2016; 17 (02) 8
- 59 Du CY, Zhou Y, Song C. et al. Is there a role of surgery in patients with recurrent or metastatic gastrointestinal stromal tumours responding to imatinib: a prospective randomised trial in China. Eur J Cancer 2014; 50 (10) 1772-1778
- 60 Patrikidou A, Chabaud S, Ray-Coquard I. et al; French Sarcoma Group. Influence of imatinib interruption and rechallenge on the residual disease in patients with advanced GIST: results of the BFR14 prospective French Sarcoma Group randomised, phase III trial. Ann Oncol 2013; 24 (04) 1087-1093