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March 2001. INVITED COMMENTARY
To Previous Article about GIST
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The term GIST has been recently introduced and arouses great controversies in regard to many aspects: definition, diagnosis, prognostic factors and treatment.
In comparison with extremity sarcomas this tumors have a much greater local failure rate and an overall 5 years survival rate of 30%, in consequence of their insidious progress and late diagnosis, often suggested at laparotomy.
Consequently diagnostic techniques are very important, in particular CT, Endoscopic Ultrasound, Staging Laparoscopy, Laparoscopic Ultrasonography that are useful for the diagnosis in emergency and for the detection of recurrences in the follow up.
In the recent retrospective and prospective studies the authors sought to include only sarcomas with standard and traditional criteria of malignancy, but the histologic criteria are not well defined. It is not uncommon for lesions of low malignant potential to metastasize decades later.
The prognostic factors have been re-examined in time: we concur with Memorial Sloan Kettering Cancer Center studies. They affirm that in the patients without metastases and who undergo complete gross resection size is an important predictor of survival on both univariate and multivariate analysis.
But the main problem is that of recurrences. They occur also in patients who had a complete resection of the tumor.
Effective adjuvant therapies are on study to diminish the recurrence rate and to treat sarcomatosis (PDT).
DeMatteo RP, Lewis JJ, Leung D, Mudan S, Woodruff MJ, Brennan MF. Two hundred gastrointestinal stromal tumors : recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231: 51-8.
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