GIST – risk of recurrence and dissemination

Introduction: GIST (gastrointestinal stromal tumours) are a rare disease constituting less than 1% of digestive tract tumours. Approximately 30% of GIST show features of malignancy with infiltration and metastases.

Aim: Evaluation of patients subjected to surgical management due to GIST tumours. Treatment outcomes, probability of recurrence or dissemination are assessment criteria.

Material and methods: The study group comprised 55 patients, 26 men and 29 women, aged between 43 and 89 (M 44-83, average 66.6; W 43-89, average 66.6) subjected to surgical treatment. Analysis included tumour localization, malignancy, type of surgery, number of recurrences or disseminations and deaths.

Results: 37 patients had gastric tumours (W-25, M-12), 2 (M) duodenal tumours, 12 (M-7, W-4) small intestine tumours, 2 (M) colonic tumours, 2 (M) rectal tumours. 51 patients were operated radically, which was confirmed on histopathological examination. One patient had disseminated disease. 33 patients were found to develop tumours of ≥5 cm, 20 patients with high degree of malignancy, 8 with medium and others with low degree of malignancy. No significant complications were recorded during the postoperative course. 15 patients died during follow-up, 4 due to dissemination of
disease. In 3 cases we noticed recurrence of disease; 1 liver metastasis, 1 bone metastasis and liver metastasis, and one small pelvis tumour. Both deaths due to dissemination and recurrences of disease were associated with high malignancy tumours (diameter >5 cm, IM >5/50 HPF).

Conclusions: Diameter of tumour >5 cm and high mitotic index (IM >5/50 HPF) are the main factors associated with bad outcome (dissemination, recurrence). In the majority of patients with recurrence of disease and dissemination, treated with imatinib, stabilization or regression of disease was observed with good quality of life.