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Two Hundred Gastrointestinal Stromal Tumors: Recurrence Patterns and Prognostic Factors for Survival

DeMatteo, Ronald P. MD*; Lewis, Jonathan J. MD, PhD*; Leung, Denis PhD; Mudan, Satvinder S. MD*; Woodruff, James M. MD; Brennan, Murray F. MD*

Original Articles

Objective To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively.

Summary Background Data A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven.

Methods Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival.

Results Of the 200 patients, 46% had primary disease without metastasis, 47% had metastasis, and 7% had isolated local recurrence. In patients with primary disease who underwent complete resection of gross disease (n = 80), the 5-year actuarial survival rate was 54%, and survival was predicted by tumor size but not microscopic margins of resection. Recurrence of disease after resection was predominantly intraabdominal and involved the original tumor site, peritoneum, and liver.

Conclusions GISTs are uncommon sarcomas. Tumor size predicts disease-specific survival in patients with primary disease who undergo complete gross resection. Tumor recurrence tends to be intraabdominal. Investigational protocols are indicated to reduce the rate of recurrence after resection and to improve the outcome for patients with GIST.

From the Departments of *Surgery, †Biostatistics, and ‡Pathology, Memorial Sloan-Kettering Cancer Center, New York City, New York

Correspondence: Murray F. Brennan, MD, Dept. of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

Presented in part at the Annual Meeting of the American College of Surgeons, October 25–30, 1998, Orlando, Florida.

Supported by USPHS Grant CA 47179 (MFB).

Accepted for publication July 26, 1999.

© 2000 Lippincott Williams & Wilkins, Inc.