Tumor invasion of the plasma membrane surface could influence the prognosis of gastrointestinal stromal tumor (GIST), according to a study recently published in the World Journal of Surgical Oncology.

“Our results suggest that tumor growth patterns are independent predictors of progression-free survival, and that the exogenous type is associated with a significantly worse prognosis than the endogenous type,” the authors wrote.

This retrospective, observational study included 496 patients previously diagnosed with GIST from a single center in China who underwent surgical resection. The majority (n=375) of the cases were exogenous tumors, and the remaining 121 were endogenous. A little over half of the patients (n=276) had tumors measuring between 2 and 5 cm, with similar proportions of exogenous and endogenous tumors of 69.92% and 30.07%, respectively. 

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Tumor growth patterns were found to be independent risk factors for progression-free survival. Specifically, underlying disease and bleeding were prognostic factors associated with overall survival. Regardless, a subsequent multivariate analysis did not reproduce these same results.

The researchers also identified other prognostic factors for progression-free survival, such as the Ki67 nuclear marker, tumor size, tumor grade, and mitotic index. Interestingly, a past history of surgery was correlated with a worse prognosis.

Importantly, although tumors measuring 2 to 5 cm in diameter are considered low risk, these results suggest that further identifying the subtype in terms of plasma membrane surface invasion could predict the prognosis, as exogenous tumors have a high risk of recurrence.

Although a multicenter prospective study must definitively determine these findings, this research highlights the importance of acknowledging all of the pertinent tumor patterns and characteristics for each patient with GIST, regardless of tumor size. Understanding these aspects could greatly influence prognosis and subsequently redirect management according to the risk factors present in each case. 

“Despite these limitations, the study provides valuable insights into clinical practice and highlights the need for clinicians to pay more attention to exogenous 2–5 cm diameter gastric mesenchymal tumors due to their higher risk of recurrence,” the authors concluded.


Lin C, Sui C, Tao T, et al. Prognostic analysis of 2–5 cm diameter gastric stromal tumors with exogenous or endogenous growth. World J Surg Oncol. 2023;21(1):139. doi:10.1186/s12957-023-03006-9