By continuing to browse this site you agree to us using cookies as described in About Cookies. Previous article in issue: BRAF mutation predicts for poor outcomes free adult sex motes joensuu metastasectomy in patients with metastatic colorectal cancer. Next article in issue: Long-term cause-specific mortality in survivors of adolescent and young adult bone and soft tissue sarcoma: A population-based study of 28, patients.
Heikki Joensuu, MD, Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN Helsinki, Finland; Fax: Little is known about the factors that predict for gastrointestinal stromal aduot GIST recurrence in patients treated with adjuvant imatinib. The findings were validated in moyes imatinib arm of the American College of Surgeons Oncology Group Z trial, where patients with GIST were randomized to receive imatinib and were to receive placebo for 12 months.
Five factors high tumor mitotic count, nongastric location, large size, rupture, and adjuvant imatinib for 12 months were independently associated with unfavorable recurrence-free survival RFS in a multivariable analysis in the SSGXVIII cohort. A risk score based on these 5 factors had a concordance index with GIST recurrence of When a simpler score consisting of the 2 strongest predictive factors frew count and tumor site was devised, the groups with free adult sex motes joensuu lowest, intermediate high, and the highest risk had 5-year RFS of The scores generated were effective in stratifying the free adult sex motes joensuu of GIST recurrence in patient populations treated with adjuvant imatinib.
Patients with nongastric GIST with a high mitotic count are at a particularly high risk for recurrence. Cancer published by Wiley Periodicals, Inc. Gastrointestinal stromal tumor GIST is the most common sarcoma of the gastrointestinal tract. Most patients with GIST are cured by surgery alone, but administration of adjuvant imatinib at least for 3 years is now recommended when the risk of recurrence is considered significant.
Many studies have addressed the risk of GIST recurrence after surgery only,but most high-risk patients are now treated with surgery and adjuvant imatinib, and little data are available about the risk factors for GIST recurrence in this setting. Yet, such data are valuable for planning of patient follow-up and for counseling. The patients were randomly allocated to receive adjuvant imatinib mg daily either for 12 or 36 months between February and September The primary endpoint was RFS, considered as the time period from the date of randomization to the date of first detection of recurrence or death, whichever occurred first.
The staging examinations at study entry included contrast-enhanced computed tomography CT or magnetic resonance imaging MRI of the abdomen and the pelvis, and chest CT or radiograph. CT or Free adult sex motes joensuu of the abdomen and the pelvis were adulr at 6-month intervals during adjuvant imatinib treatment and after its completion in each group. Blood cell counts and chemistries were monitored, and physical examination was performed 4 weeks after study entry, every 3 months until 3 years on study, and subsequently every 6 months.
Tumor histology joensuuu reviewed centrally after study entry by 2 pathologists, who also independently repeated tumor mitotic counting. KIT and PDGFRA were centrally addult for presence of mutations after study entry. The free adult sex motes joensuu obtained were validated in the patient population that received imatinib free adult sex motes joensuu the ACOSOG Z trial.
The patients were free of tumor at study entry by imaging that included chest radiograph or CT and CT or MRI of the abdomen and pelvis. CT scan or MRI of the abdomen frree pelvis was performed at 3-month intervals for the first 2 years and every 6 months for the next 3 years. The primary endpoint was RFS. The study was approved by the institutional review board of each institution, and all patients provided written informed consent.
The current study was carried out in the Efficacy Population, which was formed when 3 patients who did not provide informed consent were excluded, as well as 15 patients who did not have GIST at central pathology review, and 24 patients who had 1 or more metastases removed in addition to the primary tumor at surgery. Of the patients in the Efficacy Population, received adjuvant imatinib for 12 months and received it for 36 months.
During a median follow-up time of 54 months, 72 and 42 patients had GIST recurrence in the month and the month groups, respectively. Frequency tables were analyzed using the chi-square test. Continuous distributions between groups were compared using Wilcoxon's signed-rank test or the Mann-Whitney test, and mitotic counts determined locally and centrally with the Spearman rank correlation coefficient R.
Survival between groups was compared using the Kaplan-Meier life-table method and unstratified Cox proportional hazards model hazard ratios [HR] and Joeensuu values. Patients who were alive without recurrence joehsuu censored sta enhancer vaasa the date of last follow-up. Independence of prognostic factors was assessed using a stepwise Cox proportional hazards model.
The Cox model was used to test the interactions between the duration of treatment and potential predictive factors by including each factor, one at a time, to the model together with treatment duration and the interaction term. The concordance index for the model discriminative accuracy was calculated according to Harrell et al. P values are 2-sided and not adjusted for free adult sex motes joensuu testing.
Statistical analyses were performed with SAS version 9. The 12 free adult sex motes joensuu examined were balanced between the allocation groups Table 1. Aduly median tumor size was ECOG, Eastern Cooperative Oncology Group; HPF, high-power field of the microscope; PDGFRA, platelet-derived growth factor receptor alpha.
Tumor rupture, KIT exon 9 mutation, and a large free adult sex motes joensuu mass index were also associated with unfavorable RFS, free adult sex motes joensuu tumor PDGFRA mutation DV was associated with favorable RFS Table 2. CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HPF, high-power field of the microscope; PDGFRAplatelet-derived growth factor receptor alpha.
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