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The impact of contour maps on estimating the risk of gastrointestinal stromal tumor recurrence: indications for adjuvant therapy: an analysis of the Kinki GIST registry

Teranishi, Ryugo 大阪大学

2023.12.25

概要

Gastrointestinal stromal tumors (GISTs) represent the most
common type of gastrointestinal mesenchymal tumors and
are detected most often in the stomach, followed by the
small intestine and other sites in the colon, esophagus, and
peritoneal cavity [1–5]. Surgical resection with a negative
margin remains the only therapeutic modality for cure.
Adjuvant therapy has recently been established for
patients with a high-risk of recurrence GISTs [6, 7]. Three
randomized phase III trials evaluating the efficacy of adjuvant therapy with imatinib mesylate (IM) demonstrated the
efficacy of adjuvant therapy with IM for high-risk GIST
recurrence after resection and revealed that recurrencefree survival (RFS) was significantly prolonged in patients
treated with IM for a duration of 1–3 years, as compared
with that in controls [7–10]. Nonetheless, the eligibility
criteria for randomization of patients in each trial were
different. The first trial (i.e., the American College of
Surgeons Oncology Group Z9001 study) targeted patients
with GIST measuring ≥ 3 cm in size and reported that
adjuvant IM treatment for 1 year improved the RFS rate,
as compared with that in controls. Following this study,
patients in the high-risk group according to the National
Institutes of Health consensus criteria (NIHC) and patients
with tumor rupture were randomized in the Scandinavian
Sarcoma Group XVIII/Arbeitsgemeinschaft Internistische Onkologie study [9]. The European Organisation
for Research and Treatment of Cancer 62,024 study was
the largest phase III trial that targeted patients with primary GIST who had high and intermediate risk based on
the NIHC [8]. For these reasons, there is no consensus on
the indications for adjuvant therapy. Therefore, predicting
the patient-specific risk of GIST recurrence plays a crucial
role in determining indications for adjuvant therapy.
Several risk-stratification systems for analyzing patients
after radical resection of GISTs have been proposed. The
NIHC was proposed in 2002 and have been widely used
globally since then [11]. This classification is based on
tumor size and the number of mitotic counts per 50 highpower fields (HPFs). However, further study showed that
the location of GISTs was also one of the important and
independent prognostic factors for recurrence in patients
after radical resection. Miettinen et al. proposed the
Armed Forces Institute of Pathology Criteria; this classification involved the location of GISTs in addition to the
tumor size and number of mitotic counts [3]. The presence
of tumor rupture, which is a strong adverse prognostic
factor for GISTs and potentially important in determining
patient prognosis [12–14], is absent in these classification
systems. Therefore, Joensuu et al. ...

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