Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world

The members of the STAR ReGISTry Study Group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusPublished - 2019 Jan 1

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Guideline Adherence
Gastrointestinal Stromal Tumors
Pathology
Neoplasms
Registries
Rupture
Therapeutics
Multivariate Analysis
Guidelines
Mutation

Keywords

  • Adjuvant therapy
  • Gastrointestinal stromal tumor
  • Guidelines
  • Multidisciplinary board
  • Pathological diagnosis

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world. / The members of the STAR ReGISTry Study Group.

In: Gastric Cancer, 01.01.2019.

Research output: Contribution to journalArticle

@article{d4794238d05148c09e0a9706bf5d4e74,
title = "Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world",
abstract = "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.",
keywords = "Adjuvant therapy, Gastrointestinal stromal tumor, Guidelines, Multidisciplinary board, Pathological diagnosis",
author = "{The members of the STAR ReGISTry Study Group} and Toshirou Nishida and Yoshiharu Sakai and Masakazu Takagi and Masato Ozaka and Yuukou Kitagawa and Yukinori Kurokawa and Toru Masuzawa and Yoichi Naito and Tatsuo Kagimura and Seiichi Hirota and Takuro Saito and Yoshito Komatsu and Masato Kondo and Tsutomu Hayashi and Naoto Gotoda and Nobuhiro Takiguchi and Atsuhiko Maki and Hideo Baba and Hajime Orita and Hiroshi Yabusaki and Gaku Chiguchi and Dai Manaka and Kazuhito Nabeshima and Hiromitsu Akabane and Koichi Ono and Norihito Wada and Masahide Kaji and Kazuhiro Yoshida and Ikuo Takahashi and Kazumasa Fujitani and Sohei Matsumoto and Yutaka Tamamori and Hiroaki Saito and Shugo Ueda and Masahiro Yamamura and Hirofumi Fujii and Shigefumi Yoshino and Akihiro Suzuki and Eigo Otsuji and Shigeyuki Kawachi and Tsuyoshi Takahashi and Kazuya Muguruma and Suguru Ishikawa and Masaaki Mitsutsuji and Hiroshi Takamori and Takashi Kaiho and Akihiro Sako and Seiji Ito and Masahiro Mori and Makoto Tokuhara",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10120-019-00966-4",
language = "English",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",

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TY - JOUR

T1 - Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world

AU - The members of the STAR ReGISTry Study Group

AU - Nishida, Toshirou

AU - Sakai, Yoshiharu

AU - Takagi, Masakazu

AU - Ozaka, Masato

AU - Kitagawa, Yuukou

AU - Kurokawa, Yukinori

AU - Masuzawa, Toru

AU - Naito, Yoichi

AU - Kagimura, Tatsuo

AU - Hirota, Seiichi

AU - Saito, Takuro

AU - Komatsu, Yoshito

AU - Kondo, Masato

AU - Hayashi, Tsutomu

AU - Gotoda, Naoto

AU - Takiguchi, Nobuhiro

AU - Maki, Atsuhiko

AU - Baba, Hideo

AU - Orita, Hajime

AU - Yabusaki, Hiroshi

AU - Chiguchi, Gaku

AU - Manaka, Dai

AU - Nabeshima, Kazuhito

AU - Akabane, Hiromitsu

AU - Ono, Koichi

AU - Wada, Norihito

AU - Kaji, Masahide

AU - Yoshida, Kazuhiro

AU - Takahashi, Ikuo

AU - Fujitani, Kazumasa

AU - Matsumoto, Sohei

AU - Tamamori, Yutaka

AU - Saito, Hiroaki

AU - Ueda, Shugo

AU - Yamamura, Masahiro

AU - Fujii, Hirofumi

AU - Yoshino, Shigefumi

AU - Suzuki, Akihiro

AU - Otsuji, Eigo

AU - Kawachi, Shigeyuki

AU - Takahashi, Tsuyoshi

AU - Muguruma, Kazuya

AU - Ishikawa, Suguru

AU - Mitsutsuji, Masaaki

AU - Takamori, Hiroshi

AU - Kaiho, Takashi

AU - Sako, Akihiro

AU - Ito, Seiji

AU - Mori, Masahiro

AU - Tokuhara, Makoto

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Adjuvant therapy

KW - Gastrointestinal stromal tumor

KW - Guidelines

KW - Multidisciplinary board

KW - Pathological diagnosis

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U2 - 10.1007/s10120-019-00966-4

DO - 10.1007/s10120-019-00966-4

M3 - Article

AN - SCOPUS:85065223920

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

ER -