Journal article
Smooth muscle tumors of the gastrointestinal tract: an analysis of prognostic features in 407 cases
Modern pathology, Vol.33(7), pp.1410-1419
07/2020
DOI: 10.1038/s41379-020-0492-5
PMCID: PMC8405135
PMID: 32051556
Abstract
Smooth muscle tumors represent the second most common mural mesenchymal neoplasm in the gastrointestinal tract, but established criteria for prognostic assessment of these tumors are lacking. A large cohort of surgically resected intramural gastrointestinal smooth muscle tumors from 31 institutions was analyzed to identify potential prognostic features. Pathologic features were assessed by expert gastrointestinal and/or soft tissue pathologists at each center. Immunohistochemical confirmation was required. A total of 407 cases from the esophagus (n = 97, 24%), stomach (n = 180, 44%), small bowel (n = 74, 18%), and colorectum (n = 56, 14%) were identified. Patients ranged in age from 19 to 92 years (mean 55 years), with a slight female predominance (57%). Mean tumor size was 5.4 cm, with the largest tumor measuring 29 cm. Disease progression following surgery, defined as local recurrence, metastasis, or disease-related death, occurred in 56 patients (14%). Colorectal tumors were most likely to progress, followed by small bowel and gastric tumors. None of the esophageal tumors in this series progressed. Receiver operator characteristic analysis identified optimal cutoffs of 9.8 cm and 3 mitoses/5 mm
for discriminating between progressive and non-progressive tumors. Histologic features strongly associated with progression by univariate analysis included moderate-to-severe atypia, high cellularity, abnormal differentiation (defined as differentiation not closely resembling that of normal smooth muscle), tumor necrosis, mucosal ulceration, lamina propria involvement, and serosal involvement (P < 0.0001 for all features). Age, sex, and margin status were not significantly associated with progression (P = 0.23, 0.82, and 0.07, respectively). A risk assessment table was created based on tumor site, size, and mitotic count, and Kaplan-Meier plots of progression-free survival for each subgroup revealed progression-based tiers. Based on our findings, it appears that nonesophageal gastrointestinal smooth muscle tumors measuring >10 cm and/or showing ≥3 mitoses/5 mm
may behave aggressively, and therefore close clinical follow-up is recommended in these cases.
Details
- Title: Subtitle
- Smooth muscle tumors of the gastrointestinal tract: an analysis of prognostic features in 407 cases
- Creators
- Lindsay Alpert - University of ChicagoLei Zhao - Harvard UniversityRam Al-Sabti - University of ChicagoAndrew M Bellizzi - University of IowaRondell P Graham - Mayo ClinicRish K Pai - Mayo ClinicRaul S Gonzalez - Harvard UniversityXuefeng Zhang - Duke UniversityVanessa Smith - Duke UniversityHanlin L Wang - University of California, Los AngelesLindsey Westbrook - University of California, Los AngelesJohn R Goldblum - Cleveland ClinicAhmed Bakhshwin - Cleveland ClinicSindhu Shetty - Cleveland ClinicDavid S Klimstra - Memorial Sloan Kettering Cancer CenterJinru Shia - Memorial Sloan Kettering Cancer CenterGokce Askan - Memorial Sloan Kettering Cancer CenterMarie E Robert - Yale UniversityCourtney Thomas - Yale UniversityWendy L Frankel - The Ohio State University Wexner Medical CenterMohammed Alsomali - The Ohio State University Wexner Medical CenterCatherine Hagen - Medical College of WisconsinMohamed E Mostafa - Medical College of WisconsinMichael M Feely - University of FloridaNaziheh Assarzadegan - University of FloridaJoseph Misdraji - Harvard UniversityAngela R Shih - Harvard UniversityDiana Agostini-Vulaj - University of RochesterJeanne M Meis - The University of Texas MD Anderson Cancer CenterSherry Tang - The University of Texas MD Anderson Cancer CenterDeyali Chatterjee - Washington University in St. LouisLiang-I Kang - Washington University in St. LouisJohn Hart - University of ChicagoSang Mee Lee - University of ChicagoTheresa Smith - Roswell Park Cancer InstituteRhonda K Yantiss - Cornell UniversityErika M Hissong - Cornell UniversityZu-Hua Gao - McGill UniversityElizabeth Yiru Wu - Brown UniversityJingBo Wu - McGill UniversityMurray B Resnick - Brown UniversityReet K Pai - University of PittsburghLeona A Doyle - Harvard UniversityShefali Chopra - University of Southern CaliforniaNicole C Panarelli - Yeshiva UniversityShaomin Hu - Yeshiva UniversityTeri A Longacre - Stanford UniversityShyam Sampath Raghavan - Stanford UniversityGregory Y Lauwers - University of South FloridaMasoumeh Ghayouri - University of South FloridaHarry S Cooper - Fox Chase Cancer CenterRajeswari Nagarathinam - Fox Chase Cancer CenterSanjay Kakar - University of California, San FranciscoMojgan Hosseini - University of California San DiegoJuan Rong - University of California San DiegoJoel K Greenson - University of MichiganLaura W Lamps - University of MichiganZachary Dong - University of UtahMary P Bronner - University of Utah
- Resource Type
- Journal article
- Publication Details
- Modern pathology, Vol.33(7), pp.1410-1419
- DOI
- 10.1038/s41379-020-0492-5
- PMID
- 32051556
- PMCID
- PMC8405135
- NLM abbreviation
- Mod Pathol
- ISSN
- 0893-3952
- eISSN
- 1530-0285
- Grant note
- P30 CA013330 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
- Language
- English
- Date published
- 07/2020
- Academic Unit
- Pathology
- Record Identifier
- 9984185170002771
Metrics
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