Outcomes and Prognostic Factors of Primary Gastric GIST Following Complete Surgical Resection: A Single Surgeon Experience
* Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Affiliation : Chakrapan Euanorasetr MD*
Objective : To examine the surgical outcomes and to identify prognostic factors influencing tumor recurrence and survival
after curative resection of primary gastric GIST as performed by one surgeon.
Material and Method: The medical records of patients with primary gastric GIST (c-kit or CD117-positive) who underwent
curative resection by one surgeon between January 2001 and March 2009. The clinicopathological features, tumor recurrence,
and recurrence-free survival were assessed.
Results : Twenty-two patients (10 males and 12 females) with a median age of 66 years (range, 39-98 yrs) were reviewed.
According to the NIH risk criteria, high-risk, intermediate-risk and low-risk GISTs were found in 12 (54.5%), one (4.5%),
and nine (41%) patients, respectively. After a median follow-up of 42 months (range, 19-96 months), three patients (13.6%)
developed tumor recurrence, all of whom had high-risk GIST. No patient died during this follow-up period. The recurrence-
free probability at 5 years was 88% (95% CI; 59%-97%). Univariable analysis showed that high mitotic count (> 5/50 HPF)
was a significant predictor of tumor recurrence.
Conclusion : Low and intermediate-risk gastric GIST have an excellent prognosis after complete surgical resection alone,
while high-risk group are associated with increased disease recurrence despite complete surgical resection. Adjuvant therapy
should be advocated for patients with high-risk gastric GISTs. High mitotic count is an important prognostic factor for
recurrence after surgery.
Keywords : Curative resection, Tumor recurrence, Recurrence-free survival, NIH risk criteria, Gastrointestinal stromal tumor (GIST), Gastric GIST
