Higher enhancing tissue volume and serosal invasion detected through preoperative contrast-enhanced computer tomography (CT) could be correlated with shorter disease-free survival (DFS) in patients with a gastrointestinal stromal tumor (GIST), according to a recently published study in Abdominal Radiology.

The recurrence of high-risk GISTs after surgical resection is a common occurrence; therefore, patients that are considered to have a higher risk of recurrence receive adjuvant treatment with imatinib after surgery. Currently, the most commonly used parameters to determine if a patient should receive adjuvant therapy include tumor size, mitotic rate, and tumor size, Xiao-Shan Chen, of the Zhongshan Hospital in Shanghai, China, and colleagues, noted.

Tumor size is typically expressed as the maximal diameter of the tumor, disregarding necrotic tissue and cysts. However, there is a number of studies that suggest that the presence of necrosis and cysts could have an impact on DFS, the authors added.


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The study team noted that the cystic and necrotic components of the tumor could be separated from viable tumor components using contrast-enhanced CT and postprocessing software.

“Thus, this study was mainly aimed to evaluate whether preoperative CT quantitative features could help predict the disease-free survival after curative resection for patients with primary gastric GISTs,” they wrote.

The retrospective study collected data from over 200 patients who underwent curative intent surgery for primary gastric GIST and had a preoperatory dual-phase contrast-enhanced CT in the 30 days before the surgery. The mean follow-up period was 60 months.

The qualitative and quantitative features of the CTs were assessed by 2 abdominal radiologists with over 5 years of experience that received training before the study. Researchers used univariate and multivariate Cox regression analyses to determine independent risk factors for shorter DFS.

Statistical analysis revealed that enhancing tumor volume, meaning the part of the tumor with tumor viability excluding necrotic and cystic tissue, was an independent risk factor for shorter DFS, thus suggesting that it might outperform tumor size in predicting DFS. The serosal invasion was also associated with shorter DFS. The authors recommend performing a multicenter prospective study to verify the conclusions of the study. 

Reference

Chen, X, Yuan, W, et al. Prognostic value of preoperative CT features for disease-free survival in patients with primary gastric gastrointestinal stromal tumors after resection. Abdom Radiol. Published online October 20, 2022. doi:10.1007/s00261-022-03725-9