Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence

McCarter, M. D., Antonescu, C. R., Ballman, K. V., Maki, R. G., Pisters, P. W., Demetri, G. D., Blanke, C. D., von Mehren, M., Brennan, M. F., McCall, L., Ota, D. M., DeMatteo, R. P., American College of Surgeons Oncology Group Intergroup Adjuvant , Team (July 2012) Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg, 215 (1). 53-9; discussion 59. ISSN 1879-1190 (Electronic)1072-7515 (Linking)

URL: https://www.ncbi.nlm.nih.gov/pubmed/22726733
DOI: 10.1016/j.jamcollsurg.2012.05.008


BACKGROUND: Little is known about the outcomes of patients with microscopically positive (R1) resections for primary gastrointestinal stromal tumors (GIST) because existing retrospective series contain small numbers of patients. The objective of this study was to analyze factors associated with R1 resection and assess the risk of recurrence with and without imatinib. STUDY DESIGN: We reviewed operative and pathology reports for 819 patients undergoing resection of primary GIST from the North American branch of the American College of Surgeons Oncology Group (ACOSOG) Z9000 and Z9001 clinical trials at 230 institutions testing adjuvant imatinib after resection of primary GIST. Patient, tumor, operative characteristics, factors associated with R1 resections, and disease status were analyzed. RESULTS: Seventy-two (8.8%) patients had an R1 resection and were followed for a median of 49 months. Factors associated with R1 resection included tumor size (>/= 10 cm), location (rectum), and tumor rupture. The risk of disease recurrence in R1 patients was driven largely by the presence of tumor rupture. There was no significant difference in recurrence-free survival for patients undergoing an R1 vs R0 resection of GIST with (hazard ratio [HR] 1.095, 95% CI 0.66, 1.82, p = 0.73) or without (HR 1.51, 95% CI 0.76, 2.99, p = 0.24) adjuvant imatinib. CONCLUSIONS: Approximately 9% of 819 GIST patients had an R1 resection. Significant factors associated with R1 resection include tumor size >/= 10 cm, location, and rupture. The difference in recurrence-free survival with or without imatinib therapy in those undergoing an R1 vs R0 resection was not statistically significant at a median follow-up of 4 years.

Item Type: Paper
Uncontrolled Keywords: Adolescent Adult Aged Aged, 80 and over Antineoplastic Agents/*therapeutic use Benzamides Female Gastrointestinal Stromal Tumors/*pathology/*surgery Humans Imatinib Mesylate Male Middle Aged Neoplasm Recurrence, Local/*epidemiology Piperazines/*therapeutic use Pyrimidines/*therapeutic use Risk Factors Young Adult
Subjects: diseases & disorders > cancer > drugs and therapies
diseases & disorders > cancer > cancer types > gastrointestinal stromal tumors
CSHL Authors:
Communities: CSHL labs > Maki lab
Depositing User: Matt Covey
Date: July 2012
Date Deposited: 20 Oct 2016 18:46
Last Modified: 20 Oct 2016 18:46
PMCID: PMC3383609
Related URLs:
URI: https://repository.cshl.edu/id/eprint/33743

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