Gastrointestinal stromal tumor natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

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Overview

Most common site of involvement of GIST is stomach(70%).

Natural history

Common sites of involvement include:

• Stomach: 70%
• Small intestine: 20-25%
• Anorectum: 7%
• Oesophagus

GISTs occur not only anywhere along the gastrointestinal tract, but also in the mesentery, omentum and retroperitoneum, which is called extra-gastrointestinal GISTs. Metastatic lesions may also be seen in cases of malignant extra-gastrointestinal GISTs

Complications

• Gastrointestinal bleeding
• Bowel obstruction
• Bowel perforation
• Peritonitis
• Volvulus
• Intussusception

Prognosis

At the time of clinical presentation, the prognosis appears to be influenced by genetic events other than kinase mutations, although a particular kinase mutation may help to define the initial clinical course of a GIST. Based on retrospective studies from time periods that predated the clinical use of kinase inhibitors, current recommendations for assessing the risk of progression for a newly diagnosed primary GIST rely on three parameters:

• Mitotic index (mitoses per 50 high-power fields)
• Tumor size
• Tumor location

• Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary.
• Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor.
  • Patients with gastric GIST have been reported to have better outlook as compared to patients with extragastric GIST.
  • Patients with localized primary disease have a average survival period of 5 years.
  • Patients with malignant lesions and metastasis have an average survival period of 1-2 years.
  • Patients with mitotic rate of >10 per 50 HPF have an average survival period of 1.5-2 years
  • Patients with mitotic rate <10 per HPF have an average survival period of 8 years.

'However, the prognosis is generally regarded as poor/good/excellent.

• The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.
• The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

Refrences

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