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Gastrointestinal Stromal Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Gastrointestinal Stromal Tumors Treatment

Table 1. Risk Stratification of Primary GIST by Mitotic Index, Tumor Size, and Tumor Locationa

GIST = gastrointestinal stromal tumors; hpf = high-power field, assessed from an area that on initial screen appears to have the highest mitotic activity.
a Annual review of pathology by ANNUAL REVIEWS, INC. Reproduced with permission of ANNUAL REVIEWS, INC., in the format Internet posting via Copyright Clearance Center.[2]
b Small numbers of cases.
Mitotic Index, hpfSize, cmSite and Risk of Progressive Disease (%)
  GastricDuodenumJejunum/IleumRectum
≤5 per 50≤2None (0)None (0)None (0)None (0)
>2 ≤5Very low (1.9)Low (4.3)Low (8.3)Low (8.5)
>5 ≤10Low (3.6)Moderate (24)(Insufficient data)(Insufficient data)
>10Moderate (10)High (52)High (34)High (57)
>5 per 50≤2NoneHighb(Insufficient data)High (54)
>2 ≤5Moderate (16)High (73)High (50)High (52)
>5 ≤10High (55)High (85)(Insufficient data)(Insufficient data)
>10High (86)High (90)High (86)High (7)

Compared to other intra-abdominal sarcomas, survival in GIST patients after surgery alone is favorable.[27] In a retrospective study involving 200 patients that predated the use of TKI, the 5-year disease-specific survival rate for GIST patients with primary disease who underwent complete resection of gross disease (N = 80) was 54%, with survival predicted by tumor size; the overall disease-specific survival was 35% at 5 years.[11] Other studies, which also predated TKI, reported 5-year survival rates of 40% to 63% for patients undergoing complete resections of GIST.

In the retrospective study of 200 patients cited in Table 1 above, 7% had isolated local recurrence and 47% had metastasis.[11] The site of relapse for GIST is usually intra-abdominal, involving the peritoneum, the liver, or both; true local recurrences are uncommon, and typically there is widespread intraperitoneal recurrence that may not be detectable by imaging techniques.[27] The median disease-specific survival of patients with metastatic GIST (N = 94) was 19 months.[11] In one retrospective study involving 119 patients with metastatic GIST, it was found that once a GIST becomes metastatic, kinase genotype did not factor into overall survival.[28]

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