Microscopically positive margins for primary gastrointestinal stromal tumors: Analysis of risk factors and tumor recurrence Journal Article

   

Authors:	Mccarter, M. D.; Antonescu, C. R.; Ballman, K. V.; Maki, R. G.; Pisters, P. W. T.; Demetri, G. D.; Blanke, C. D.; von Mehren, M.; Brennan, M. F.; McCall, L.; Ota, D. M.; DeMatteo, R. P.
Article Title:	Microscopically positive margins for primary gastrointestinal stromal tumors: Analysis of risk factors and tumor recurrence
Abstract:	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. © 2012 American College of Surgeons.
Keywords:	adolescent; adult; aged; aged, 80 and over; middle aged; young adult; major clinical study; microscopy; antineoplastic agents; follow up; gastrointestinal stromal tumor; imatinib; tumor localization; gastrointestinal stromal tumors; neoplasm recurrence, local; tumor volume; bleeding; risk factors; pyrimidines; risk assessment; colorectal tumor; tumor recurrence; mitosis rate; piperazines; stomach tumor; recurrence free survival; rupture; surgical patient; gastrointestinal tumor; small intestine tumor; tumor rupture
Journal Title:	Journal of the American College of Surgeons
Volume:	215
Issue:	1
ISSN:	1072-7515
Publisher:	Elsevier Science, Inc.
Date Published:	2012-07-01
Start Page:	53
End Page:	59
Language:	English
DOI:	10.1016/j.jamcollsurg.2012.05.008
PROVIDER:	scopus
PMCID:	PMC3383609
PUBMED:	22726733
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84862988334&partnerID=40&md5=5979527edd1d0e2a982c1baf4dae5c06
Notes:	--- - "Export Date: 1 August 2012" - "CODEN: JACSE" - "Source: Scopus"

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