Among the current classifications, many authors consider the MSKCC prognostic nomogram more feasible in clinical practice than the other classifications, even though it was not faultless in predicting the RFS. Furthermore, the main limitation of MSKCC nomogram remains the nonlinear consideration of mitotic count. Laparoscopy should not be considered as a negative prognostic factor, if oncological radicality has been respected. A good staging is also important in small GIST to avoid over/undertreatment. EUS seems to be the most valid tool for the correct characterization of these tumors. Imatinib therapy is recommended in high-grade GIST. Some studies suggest that adjuvant imatinib therapy should be prolonged for at least 5 years in high-grade GISTs, because of prolonged RFS. Probably, risk scores should be enriched with other factors such as radiological signs and biological markers. There are several studies about new prognostic factors especially in biological field. These factors need to be further investigated in order to validate their use in risk stratification. The genetic landscape of GIST appears to be very heterogeneous; a deeper understanding of the molecular mechanism underlying GIST progression would hopefully improve risk assessment. What we can hope is a new prognostic classification based only on biological markers, which could be more reliable than current classifications.
The authors report no conflicts of interest in this work.
Alessandra Greco,1 Sabrina Rossi,2 Cesare Ruffolo,1 Bruno Pauletti,3 Angelo Paolo Dei Tos,2 Giovanni Morana,4 Marco Massani3
1IV Department of Surgery, Regional Hospital Treviso, Treviso, Italy; 2Pathology Department, University of Padova and Regional Hospital, Treviso, Italy; 3III Department of Surgery, Regional Hospital Treviso, Treviso, Italy; 4Surgical Department, Regional Hospital Treviso, Treviso, Italy
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Source: Gastrointestinal Cancer: Targets and Therapy.
Originally published December 3, 2018.