Gastrointestinal Stromal Tumors Risk of Recurrence Stratification by Tumor Volume is a Best Predictor Compared with Risk Based on Mitosis and Tumor Size

  • Leonardo S. Lino-Silva
  • Patricia Segales-Rojas
  • Eduardo Aguilar-Cruz
  • Rosa A. Salcedo-Hernández
  • César Zepeda-Najar
Original Research



Gastrointestinal stromal tumors (GIST) have the potential to recur and metastasize. Several prognostic schemes have been developed, mostly based on the mitotic count, diameter, and tumor site. However, these systems are not precise enough. The research question was whether the tumor size determined by volumetry allows a better risk stratification than the traditional system, and our aim was to determine the value of tumor volumetry, a feasible and simple parameter, in the recurrence of GIST.


Seventy-four cases of GIST were studied. The cases presented with non-metastatic disease, which were resected and did not receive imatinib. We compared the clinico-pathologic features of the cases with recurrence against those with non-recurrence and compared the tumor volumetry against the classification system based on tumor size and mitosis.


The median age was 58 years (range: 25 to 91 years). Half of the cases were presented in the stomach. The tumor size had a median of 8 cm (range of 1–30 cm). The median mitosis count for 50 HPF was 4 (range 0–92). During the period of study, 16 (21.6%) patients suffered recurrence. The significant differences were that patients with recurrence accounted for more deaths and the follow-up period was larger. The area under the curve (AUC) of the volumetry classification was superior to the AUC of the classification system based on tumor size and mitosis (NIH-criteria) (p = .05).


Tumor volumetry calculated in the surgical specimen and/or pre-operative tomography was superior to the NIH consensus in stratifying the risk of recurrence in GIST.


Gastrointestinal stromal tumors GIST Cancer Recurrence Volumetry 



We would like to thank Fermín Álvarez, MStat, for reviewing the statistical design and procedures.

Declaration of authorship

All authors meet the criteria for authorship as per the guidelines of the International Committee of Medical Journal Editors (ICMJE), and all have participated at (1) conception or design of the work or the acquisition, analysis, or interpretation of data for the work; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version submitted; and (4) agreement to be accountable for all aspects of the work regarding the accuracy or integrity of the research.

Compliance with Ethical Standards

This study was conducted following the statements of Helsinki declaration and was approved by the Ethics in Investigation Board of our Institution with a waiver of informed consent.

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Leonardo S. Lino-Silva
    • 1
    • 2
  • Patricia Segales-Rojas
    • 1
  • Eduardo Aguilar-Cruz
    • 2
  • Rosa A. Salcedo-Hernández
    • 3
  • César Zepeda-Najar
    • 4
  1. 1.Surgical PathologyInstituto Nacional de CancerologíaMexico CityMexico
  2. 2.Anatomic Pathology, Gastrointestinal Pathology DivisionInstituto Nacional de Cancerología de México (Mexico’s National Cancer Institute)Mexico CityMexico
  3. 3.Surgical OncologyInstituto Nacional de CancerologíaMexico CityMexico
  4. 4.Surgical OncologyHospital Ángeles TijuanaTijuanaMexico

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