Understanding the critical role for surgery in the management of wild-type gastrointestinal stromal tumor (GIST)

Recently in the Journal of Clinical Oncology, Weldon and coworkers from the National Institutes of Health reported a retrospective single institution experience with patient outcomes following the surgical treatment of WT gastrointestinal stromal tumor (GIST). Main outcomes examined was the association of surgery with event free survival (EFS) (1). Overall, the study reported a 1-, 5-, and 10-year EFS of 73%, 24%, and 16% respectively. Tumor biology factors such as metastatic disease [adjusted hazard ratio (AHR) =2.3; confidence interval (CI): 1.0–5.1; P=0.04) and >5 mitoses per 50 high-power fields (AHR =2.5; CI: 1.1–6.0; P=0.03) had a significantly increased hazard of disease progression or recurrence. In contrast, surgical considerations such as microscopic resection margin and type of gastric resection (wedge vs. anatomic) were not significantly associated with EFS.