Gastrointestinal stromal tumors: Clinicopathological features and outcome-Real-world experience.

Abstract

Background: Gastrointestinal stromal tumors (GISTs) are rare neoplasms with diverse clinical profiles and treatment outcomes. This study aims to evaluate the clinical characteristics, treatment modalities and survival outcomes of patients with GISTs treated at a tertiary care hospital in India.

Methods: We conducted a retrospective analysis of 51 patients with GISTs. Data collected included tumor location, gender, presenting complaints, staging, pathological data, National Institutes of Health (NIH) risk category, treatment offered and outcome. Statistical analyses were performed using SPSS Statistics version 23. Descriptive statistics were used to summarize data and significance was determined with p-values < 0.05.

Results: Total 51 patients of GIST were included in this study. Mean age of presentation was 54.38 ± 13.2 and 61% (31/51) patients were male. In this study, most common site of involvement was the small bowel (25/51), followed by stomach (24/51). Most common presenting feature was  pain in abdomen (59% 30/51), followed by gastrointestinal bleed. At diagnosis, localized disease was present in a majority of patients and metastasis was present in only 10% (5/51) of cases. Among non-metastatic disease, spindle cell morphology was predominant (71.7%) and in metastatic disease; mixed cell morphology was more common (60%). Mitotic activity (0.034) and CD34 positivity (p = 0.046) were significantly associated with metastasis. According to NIH risk classification, 33% were low risk, 27% intermediate risk and 39% high risk. Imatinib was given to 75% of patients, while 25% received no drug therapy.

Conclusion: GISTs predominantly affect proximal bowel and metastatic disease is very uncommon. Surgical resection with adjuvant tyrosine kinase inhibitor in selected patient is the main treatment with good survival rate. CD34 positivity and mitotic activity was significantly associated with metastasis, indicating its potential as a marker for predicting metastatic spread.