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Gastrointestinal (GI) bleeding, one of the most common clinical manifestations of gastrointestinal stromal tumors (GISTs), worsens overall survival (OS) in GIST patients, compared to non-bleeding patients, according to a systematic literature review published in Technology in Cancer Research & Treatment.

They also discovered the following 5 factors as significant in impacting the risk of GI bleeding in people with GIST: 

  • Older age 
  • GIST location in the small intestine 
  • Tumor diameter being 5 cm or more 
  • Mitotic index ≥5/50 of high power field (HPF)
  • Tumor rupture. 

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GI bleeding in GIST patients has long been established as a major prognostic indicator. The modified National Institutes of Health (NIH) risk classification scheme has compiled a list of other risk factors that significantly impact prognosis, such as tumor location and tumor size. The purpose of this study was to focus primarily on the relationship between GI bleeding and its impact on prognosis, and look into some of the other risk factors as highlighted by the NIH. 

Among the inclusion criteria for this review were: 

  • Literature published in China and overseas
  • Research on the impact of bleeding on prognosis
  • Statistics on prognostic indicators of OS, disease-free survival (DFS), or recurrence-free survival (RFS).

A total of 12 articles, including 2781 GIST patients, were included in the study. The key findings were: 

  • The OS of GIST patients who had GI bleeding was significantly worse (HR=2.54, 95% CI, 1.13-5.73, P =.025).
  • There was no significant difference in RFS between GI bleeding GIST patients and non-bleeding patients (HR=1.35, 95% CI, 0.70-2.61, P =.371).

This research is valuable in proving existing paradigms about the risk factors for bleeding in GIST patients and exploring their impact on prognosis. 


Fan X, Han H, Sun Z, et al. Prognostic value of bleeding in gastrointestinal stromal tumors: a meta-analysis. Technol Cancer Res Treat. Published online July 29, 2021. doi:10.1177/15330338211034259