Aan onderstaande informatie de meest recente studie over aanpak van GIST tumoren toegevoegd. Hier het abstract maar voor volledige studierapport klikt u hier:
Cancer Res Treat. 2010 Sep;42(3):135-43. Epub 2010 Sep 30.
Clinicopathological and immunohistochemical features of gastointestinal stromal tumors.
Department of Pathology, Keimyung University School of Medicine, Daegu, Korea.
PURPOSE: The purpose of this study was to evaluate the clinicopathological features and immunohistochemical features of gastrointestinal stromal tumor (GIST), and specifically the expressions of platelet derived growth factor receptor A (PDGFRA), protein kinase C theta (PKC theta), discovered on GIST-1 (DOG-1), p16 and p27.
MATERIALS AND METHODS: Total 118 patients who underwent surgical resection for GIST at our institution between Jan 1997 and Dec 2007 were retrospectively studied. Immunohistochemical staining for c-kit, PDGFRA, PKC-theta, DOG-1, p16 and p27 was performed on a tissue microarray of the 118 GIST. The clinicopathologic parameters, the disease-free survival (DFS) and the overall survival rate were analyzed along with immunohistochemistry.
RESULTS: The immunohistochemical stains for c-kit, CD34, PKC-theta, PDGFRA, DOG-1, p16 and p27 were positive in 89.8%, 72.0%, 56.8%, 94.9%, 90.7%, 69.5% and 44.1% of the tumor samples, respectively. The immunohistochemical expression of c-kit was strongly correlated with PKC-theta (p=0.000), DOG-1 (p=0.000) and CD34 (p=0.002). The DFS rate was significantly decreased for the patients with peritoneal GIST, high risk GIST, ≥10 cm-sized GIST, ≥10 mitoses/50 high power fields (HPFs) and p16 positivity (p=0.001, p=0.004, p=0.001, p=0.003 and p=0.028). GISTs ≥10 cm, epithelioid tumor cell type, and c-kit, and DOG-1 negativity were significantly associated with shorter period of overall survival (p=0.048, p=0.006, p=0.000 and p=0.000).
CONCLUSION: The expression of p16 and no expression of c-kit and DOG-1 in GISTs, as well as peritoneal tumor site, high risk group, large tumor size, epithelioid tumor cell type and numerous mitoses, may be potentially prognostic factors for predicting worse outcome for patients who suffer from GIST.
PMID: 20948918 [PubMed - in process]PMCID: PMC2953776Free PMC Article
21 juli 2006: Bron: Medscape en Ann Surg. 2006; 243(6):738-747. ©2006 Lippincott Williams & Wilkins
Een laparoscopische verwijdering van kleine en middelgrote GIST tumoren (Gastric Gastrointestinal Stromal Tumors ) geeft een uitstekend resultaat , 92% van de patienten - 46 van de 50 deelenmers aan deze studie - waarbij in eerste instantie sprake was van een volledig geslaagde verwijdering waren na 36 maanden nog steeds ziektevrij. Ook de bijwerkingen waren minimaal. In deze studie zijn ook patienten met middelgrote tumoren behandeld en ook hiermee bleken de resultaten dus meer dan goed. Hier een samenvatting van een groot verklarend artikel van Medscape over deze studie.
Long-term Outcomes of Laparoscopic Resection of Gastric Gastrointestinal Stromal Tumors CME Posted 07/12/2006
Yuri W. Novitsky, MD; Kent W. Kercher, MD; Ronald F. Sing, DO; B. Todd Heniford, MD Disclosures
Abstract and Introduction
Gastric gastrointestinal stromal tumors (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of minimally invasive resection of gastric GIST has been established, the long-term safety and efficacy of these techniques are unclear. We hypothesized that complete resection of gastric GISTs using a combination of laparoscopic or laparoendoscopic techniques results in low perioperative morbidity and an effective long-term control of the disease.
Between August 1996 and June 2005, 50 consecutive patients undergoing laparoscopic or laparoendoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics and outcomes, operative findings, morbidity, and histopathologic characteristics of the tumor. Patient and tumor characteristics were analyzed to identify risk factors for tumor recurrence.
Fifty patients, mean age 60 years (range, 34-84 years), underwent 47 local and 3 segmental laparoscopic gastric resections. GI bleeding and dyspepsia were the most common symptoms. Mean tumor size was 4.4 cm (range, 1.0-8.5 cm) with the majority of the lesions located in the proximal stomach. Mean operative time was 135 minutes (range, 49-295 minutes), the mean blood loss was 85 mL (range, 10-450 mL), and the mean length of hospitalization was 3.8 days (range 1-10 days). There were no major perioperative complications or mortalities. All lesions had negative resection margins (range, 2-45 mm). Nine patients had 10 or more mitotic figures per 50 high power fields, while 11 had ulceration and/or necrosis of the lesion. At a mean follow-up of 36 months, 46 (92%) patients were disease free, 1 patient was alive with disease, 1 patient with metastases died of a cardiac event, and 2 (4%) patients died of metastatic disease. No local or port site recurrences have been identified. Patient age, tumor size, mitotic index, tumor ulceration, and necrosis were statistically associated with tumor recurrence. The presence of 10 or more mitotic figures per 50 high power fields was an independent predictor of disease progression (P = 0.006).
A laparoscopic approach to surgical resection of gastric GIST is associated with low morbidity and short hospitalization. As found in historical series of open operative resection, the tumor mitotic index predicts local recurrence. The long-term disease-free survival of 92% in our study establishes laparoscopic resection as safe and effective in treating gastric GISTs. Given these findings as well as the advantages afforded by minimally invasive surgery, a laparoscopic approach may be the preferred resection technique in most patients with small- and medium-sized gastric GISTs.
Yuri W. Novitsky, MD, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina Kent W. Kercher, MD, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina Ronald F. Sing, DO, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina B. Todd Heniford, MD, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina Charles P Vega, MD, Associate Professor, Residency Director, Department of Family Medicine, University of California, Irvine Disclosure: Yuri W. Novitsky, MD, has disclosed no relevant financial relationships. Disclosure: Kent W. Kercher, MD, has disclosed no relevant financial relationships. Disclosure: Ronald F. Sing, DO, has disclosed no relevant financial relationships. Disclosure: B. Todd Heniford, MD, has disclosed no relevant financial relationships. Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer. Ann Surg. 2006; 243(6):738-747. ©2006 Lippincott Williams & Wilkins
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