Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world.
Aged
Anoctamin-1
/ metabolism
Antineoplastic Agents
/ adverse effects
Chemotherapy, Adjuvant
Female
Gastrointestinal Stromal Tumors
/ drug therapy
Guideline Adherence
Humans
Imatinib Mesylate
/ adverse effects
Male
Middle Aged
Neoplasm Proteins
/ metabolism
Prospective Studies
Proto-Oncogene Proteins c-kit
/ genetics
Receptor, Platelet-Derived Growth Factor alpha
/ genetics
Registries
Adjuvant therapy
Gastrointestinal stromal tumor
Guidelines
Multidisciplinary board
Pathological diagnosis
Journal
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
17
02
2019
accepted:
15
04
2019
pubmed:
2
5
2019
medline:
30
5
2020
entrez:
2
5
2019
Statut:
ppublish
Résumé
A multidisciplinary approach based on guidelines and pathological diagnosis by specialized pathologists are important for improving the prognosis and QoL of GIST patients. This study examined the adherence to the guidelines and the concordance of the pathological diagnosis of high-risk GISTs. Among 541 patients with high-risk GISTs recruited to the prospective registry between Dec. 2012 and Dec. 2015, 534 patients were analyzed after central pathology with KIT and DOG1 IHC and genotyping of KIT and PDGFRA. Of the 534 patients, 432 (81%) received imatinib adjuvant therapy at a starting dose of 400 or 300 mg/day. Multivariate analysis indicated that age (HR 0.71; 95% CI 0.58-0.88), tumor size (HR for > 10 cm vs < 5 cm, 3.87; 95% CI 1.72-8.74), mitosis (HR for > 10 vs < 5, 3.54; 95% CI 1.84-6.79), tumor rupture (HR 3.69; 95% CI 1.43-9.52) and performance status (HR 0.55; 95% CI 0.31-0.99) were independently related to adjuvant therapy. Among the 534 high-risk GISTs diagnosed locally, 19 tumors (3.6%) were diagnosed as non-GISTs, and the other 93 (18.1%) GISTs were reclassified into lower risk categories by central pathology. Among 10 patients with non-GISTs and 8 patients with PDGFRA D842V mutations, 4 (40%) and 3 (38%) patients, respectively, continued the therapy after receiving the central pathology results. The adherence to guidelines and the concordance of pathological diagnoses were comparatively good for high-risk GISTs. Central pathology may contribute to improved diagnosis, but further refinements may be required.
Sections du résumé
BACKGROUND
A multidisciplinary approach based on guidelines and pathological diagnosis by specialized pathologists are important for improving the prognosis and QoL of GIST patients. This study examined the adherence to the guidelines and the concordance of the pathological diagnosis of high-risk GISTs.
PATIENTS AND METHODS
Among 541 patients with high-risk GISTs recruited to the prospective registry between Dec. 2012 and Dec. 2015, 534 patients were analyzed after central pathology with KIT and DOG1 IHC and genotyping of KIT and PDGFRA.
RESULTS
Of the 534 patients, 432 (81%) received imatinib adjuvant therapy at a starting dose of 400 or 300 mg/day. Multivariate analysis indicated that age (HR 0.71; 95% CI 0.58-0.88), tumor size (HR for > 10 cm vs < 5 cm, 3.87; 95% CI 1.72-8.74), mitosis (HR for > 10 vs < 5, 3.54; 95% CI 1.84-6.79), tumor rupture (HR 3.69; 95% CI 1.43-9.52) and performance status (HR 0.55; 95% CI 0.31-0.99) were independently related to adjuvant therapy. Among the 534 high-risk GISTs diagnosed locally, 19 tumors (3.6%) were diagnosed as non-GISTs, and the other 93 (18.1%) GISTs were reclassified into lower risk categories by central pathology. Among 10 patients with non-GISTs and 8 patients with PDGFRA D842V mutations, 4 (40%) and 3 (38%) patients, respectively, continued the therapy after receiving the central pathology results.
CONCLUSIONS
The adherence to guidelines and the concordance of pathological diagnoses were comparatively good for high-risk GISTs. Central pathology may contribute to improved diagnosis, but further refinements may be required.
Identifiants
pubmed: 31041650
doi: 10.1007/s10120-019-00966-4
pii: 10.1007/s10120-019-00966-4
pmc: PMC6942594
doi:
Substances chimiques
ANO1 protein, human
0
Anoctamin-1
0
Antineoplastic Agents
0
Neoplasm Proteins
0
Imatinib Mesylate
8A1O1M485B
KIT protein, human
EC 2.7.10.1
Proto-Oncogene Proteins c-kit
EC 2.7.10.1
Receptor, Platelet-Derived Growth Factor alpha
EC 2.7.10.1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
118-125Subventions
Organisme : Aviation and Missile Research, Development, and Engineering Center (US)
ID : 28-A-16
Pays : International
Investigateurs
Takuro Saito
(T)
Yoshito Komatsu
(Y)
Masato Kondo
(M)
Tsutomu Hayashi
(T)
Yoshiharu Sakai
(Y)
Naoto Gotoda
(N)
Nobuhiro Takiguchi
(N)
Atsuhiko Maki
(A)
Hideo Baba
(H)
Hajime Orita
(H)
Hiroshi Yabusaki
(H)
Gaku Chiguchi
(G)
Dai Manaka
(D)
Kazuhito Nabeshima
(K)
Hiromitsu Akabane
(H)
Koichi Ono
(K)
Norihito Wada
(N)
Masahide Kaji
(M)
Kazuhiro Yoshida
(K)
Ikuo Takahashi
(I)
Kazumasa Fujitani
(K)
Sohei Matsumoto
(S)
Yutaka Tamamori
(Y)
Hiroaki Saito
(H)
Shugo Ueda
(S)
Masahiro Yamamura
(M)
Hirofumi Fujii
(H)
Shigefumi Yoshino
(S)
Akihiro Suzuki
(A)
Eigo Otsuji
(E)
Shigeyuki Kawachi
(S)
Tsuyoshi Takahashi
(T)
Kazuya Muguruma
(K)
Suguru Ishikawa
(S)
Masaaki Mitsutsuji
(M)
Hiroshi Takamori
(H)
Takashi Kaiho
(T)
Akihiro Sako
(A)
Seiji Ito
(S)
Masahiro Mori
(M)
Makoto Tokuhara
(M)
Yoshihiko Kawaguchi
(Y)
Naoki Hirabayashi
(N)
Motohira Yoshida
(M)
Masazumi Takahashi
(M)
Shiro Takase
(S)
Keishi Yamashita
(K)
Yoshiaki Iwasaki
(Y)
Yutaka Ozeki
(Y)
Yasunori Nishida
(Y)
Keisuke Koeda
(K)
Toshimasa Tsujinaka
(T)
Hiroshi Kanie
(H)
Shinji Hato
(S)
Junya Morimoto
(J)
Hiroshi Honda
(H)
Hirotaka Tashiro
(H)
Yoshihiro Kakeji
(Y)
Hiroaki Hata
(H)
Toshiro Sugiyama
(T)
Takayuki Nobuoka
(T)
Ryoji Fukushima
(R)
Katsuro Sugiyama
(K)
Junichi Hasegawa
(J)
Tsunehiro Yoshimura
(T)
Atsuo Takashima
(A)
Chikara Kunisaki
(C)
Hiroharu Shinozaki
(H)
Naoto Senmaru
(N)
Hiroshi Imamura
(H)
Satoshi Otsu
(S)
Daisuke Kobayashi
(D)
Akinori Noguchi
(A)
Akinori Takagane
(A)
Atsushi Mitsunaga
(A)
Shigeyuki Tamura
(S)
Jin Matsuyama
(J)
Yoshio Oka
(Y)
Kiyoshi Kajiyama
(K)
Takuji Yamada
(T)
Sumito Hoshino
(S)
Hideki Ohdan
(H)
Tomokazu Kakishita
(T)
Katsuhiko Yanaga
(K)
Yasushi Rino
(Y)
Takayuki Takahashi
(T)
Hisahiro Matsubara
(H)
Masahiro Ishizaki
(M)
Songtae Kim
(S)
Noriyuki Inaki
(N)
Noriyuki Hirahara
(N)
Masaru Morita
(M)
Tatsuo Kanda
(T)
Tomoki Yamatsuji
(T)
Mitsutoshi Tatsumi
(M)
Chikara Ebisui
(C)
Yoshifumi Ikeda
(Y)
Tsukasa Inoue
(T)
Wataru Kimura
(W)
Hiroyuki Nakaba
(H)
Takamune Shibaji
(T)
Taichi Tatsubayashi
(T)
Masahiro Sakon
(M)
Yo Isobe
(Y)
Mitsuo Shimada
(M)
Mitsuru Sasako
(M)
Hirofumi Tomori
(H)
Koichi Demura
(K)
Masahiro Fujikawa
(M)
Hirohito Ishizuka
(H)
Masanari Tendo
(M)
Shinichi Sakuramoto
(S)
Akiyoshi Kanazawa
(A)
Norimasa Fukushima
(N)
Seiji Sato
(S)
Takaomi Takahata
(T)
Tetsuya Kusumoto
(T)
Takeshi Omori
(T)
Masanobu Takahashi
(M)
Masahiro Inoue
(M)
Norimitsu Tanaka
(N)
Motoki Ninomiya
(M)
Yasufumi Teramura
(Y)
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