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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2012 December;25(6):419-20
Clinical features and prognosis of gastrointestinal stromal tumors (GIST) in elderly patients: a 5-year retrospective study
Guida F., Conte P., Braun A., Ferronetti A., Canfora A., Aprea G.
Department of General and Geriatric Surgery and Diagnostic and Operative Endoscopy “Federico II” University of Naples, Naples, Italy
AIM: GastroIntestinal stromal tumors (GISTs) are mesenchymal neoplasm arising in the abdomen: stomach is the most common site of origin accounting for 50-60% of these tumors. The aim of this study was to assess the clinical features and the factors influencing the prognosis of elderly patients affected by abdominal GIST.
METHODS: Patients were divided into two groups for age: group 1 (patients < 70 years old) and group 2 (patients ≥70 years old). Since January 2004 to December 2005, thirty patients were admitted to the study: 18 patients in group 1 and 12 patients in group 2.
RESULTS: In group 2 there was a higher rate of gastric (66% vs. 56%) and jejuna GIST (17% vs. 0%); in group 1 we had a greater incidence of ileal GIST (44% vs. 17%). In group 1 the initial symptoms were GI hemorrhage or intestinal occlusion, while in group 2 severe sideropenic anemia was the first clinical sign of GIST. Group 2 patients had a greater incidence of high-risk GIST and histological analysis showed in this group a prevalence of spindle cell GIST (58% vs. 44%). Dimensional analysis showed that in group 2 GIST had greater dimensions (6.5 cm vs. 4.5 cm) and presented more frequently mucosal ulceration (67% vs. 33%). Adjuvant therapy with imatinib was performed in 8 patients of group 1. GISTs-related 5-year mortality was 33% in group 2 and 11% in group 1.
CONCLUSION: In our study elderly patients affected by GISTs have a poorer prognosis than younger patients with a 5-year mortality of 33%. This is due to several factors: the silent clinical course and the greater dimensions at diagnosis, more frequent presence of high-risk histotype and the presence of mucosal ulceration. Elderly patients with GIST need a closer follow-up for the higher risk of recurrence.