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

Martin D. McCarter, Cristina R. Antonescu, Karla V. Ballman, Robert G. Maki, Peter W T Pisters, George D. Demetri, Charles D. Blanke, Margaret Von Mehren, Murray F. Brennan, Linda McCall, David M. Ota, Ronald P. DeMatteo

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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.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalJournal of the American College of Surgeons
Volume215
Issue number1
DOIs
StatePublished - Jul 2012

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Gastrointestinal Stromal Tumors
Recurrence
Neoplasms
Rupture
Survival
Rectum
Statistical Factor Analysis
Clinical Trials
Pathology
Imatinib Mesylate

ASJC Scopus subject areas

  • Surgery

Cite this

McCarter, M. D., Antonescu, C. R., Ballman, K. V., Maki, R. G., Pisters, P. W. T., Demetri, G. D., ... DeMatteo, R. P. (2012). Microscopically positive margins for primary gastrointestinal stromal tumors: Analysis of risk factors and tumor recurrence. Journal of the American College of Surgeons, 215(1), 53-59. https://doi.org/10.1016/j.jamcollsurg.2012.05.008

Microscopically positive margins for primary gastrointestinal stromal tumors : Analysis of risk factors and tumor recurrence. / McCarter, Martin D.; Antonescu, Cristina R.; Ballman, Karla V.; Maki, Robert G.; Pisters, Peter W T; Demetri, George D.; Blanke, Charles D.; Von Mehren, Margaret; Brennan, Murray F.; McCall, Linda; Ota, David M.; DeMatteo, Ronald P.

In: Journal of the American College of Surgeons, Vol. 215, No. 1, 07.2012, p. 53-59.

Research output: Contribution to journalArticle

McCarter, MD, Antonescu, CR, Ballman, KV, Maki, RG, Pisters, PWT, Demetri, GD, Blanke, CD, Von Mehren, M, Brennan, MF, McCall, L, Ota, DM & DeMatteo, RP 2012, 'Microscopically positive margins for primary gastrointestinal stromal tumors: Analysis of risk factors and tumor recurrence', Journal of the American College of Surgeons, vol. 215, no. 1, pp. 53-59. https://doi.org/10.1016/j.jamcollsurg.2012.05.008
McCarter, Martin D. ; Antonescu, Cristina R. ; Ballman, Karla V. ; Maki, Robert G. ; Pisters, Peter W T ; Demetri, George D. ; Blanke, Charles D. ; Von Mehren, Margaret ; Brennan, Murray F. ; McCall, Linda ; Ota, David M. ; DeMatteo, Ronald P. / Microscopically positive margins for primary gastrointestinal stromal tumors : Analysis of risk factors and tumor recurrence. In: Journal of the American College of Surgeons. 2012 ; Vol. 215, No. 1. pp. 53-59.
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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.",
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AU - McCarter, Martin D.

AU - Antonescu, Cristina R.

AU - Ballman, Karla V.

AU - Maki, Robert G.

AU - Pisters, Peter W T

AU - Demetri, George D.

AU - Blanke, Charles D.

AU - Von Mehren, Margaret

AU - Brennan, Murray F.

AU - McCall, Linda

AU - Ota, David M.

AU - DeMatteo, Ronald P.

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N2 - 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.

AB - 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.

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