Academic Journal
Main Category: GastroIntestinal / Gastroenterology
Also Included In: Cancer / Oncology
Article Date: 07 Dec 2011 - 9:00 PST
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According to a study published Online First in The Lancet Oncology, a new tool that can assess a person's risk of gastrointestinal stromal tumors recurrence after surgery is an important addition to current predictive models that will also help with the development of more accurate selection of high-risk patients who are most likely to benefit from additional treatment. The study suggests that the new prognostic maps could reduce costs and minimize unnecessary side effects in 60% of patients who are likely to be cured by surgery alone.
Even though many patients with GIST, the most common soft tissue cancer of the intestinal tract, stand a good chance of being cured by surgery alone, they still receive supplementary imatinib therapy. In order to predict the recurrence risk of each patient accurately, but also to identify those who tend to benefit most from receiving additional therapy, it is vital to ensure that those with a high risk of recurrence can be aggressively treated, whilst those with a lesser risk are not being over treated and exposed to needless side-effects.
The current methods of risk-prediction which use established prognostic factors of tumor size and mitotic count, are commonly used, however, their accuracy at predicting the recurrence risk is not known.
Leading researchers Heikki Joensuu from Helsinki University Central Hospital in Helsinki, Finland, and his team developed a database on 2,560 patients with operable GIST who received no additional therapy. The researchers identified the number of patients by combining individual patient data from population-based cohorts and evaluated key prognostic factors for recurrence free survival (RFS). They also compared the performance of three widely used risk-prediction methods, such as the National Institute of Health [NIH], the modified consensus criteria, and the Armed Forces Institute of Pathology [AFIP] criteria), and subsequently designed a new approach for estimating the risk of GIST recurrence.
Their findings revealed that 59.9% of patients, i.e. the majority were cured by surgery alone, suggesting they would not benefit from additional therapy.
The researchers noted that the estimated 10-year risk of GIST recurrence was relatively accurate during a comparison of the three main risk-stratification models. They observed that the modified NIH consensus criteria were the best at detecting a single group of patients who had an unfavorable prognosis and who tended to benefit most from additional therapy.
The researchers decided to develop new prognostic maps, which portrayed the continuous ad non-linear nature of these variables more accurately given that tumor size and mitosis count demonstrated a non-linear link to the recurrence risk. They accounted for tumor location and rupture, which was identified as an independent risk factor and found that their newly developed prognostic maps offered the most accurate prognosis for individual GIST patients compared with conventional models, which categorized patients into a few broad groups.
In a concluding statement the researchers say:
"In practice, the modified consensus criteria identify well those patients who have little risk of GIST recurrence and who may thus not be candidates for adjuvant therapies. There are, however, patients whose risk borders the high-risk group or who wish their risk to be estimated using another method and perhaps more individually. The prognostic heat maps and contour maps can be illustrative and helpful in such cases."
Anette Duensing from the University of Pittsburgh Cancer Institute in Pittsburgh, USA, talks about the results in a linked comment stating:
"Give clinicians a solid foundation, method, and reason to separate the subset of high-risk patients who are likely to benefit from adjuvant therapy from those who will do just as well without it. This personalized approach will ultimately reduce costs and side effects in patients who are cured by surgery alone, and allow a focus on high-risk patients who need more intense treatment. Although the current risk-prediction schemes will probably remain standard for pathologists, the contour maps will be crucial for oncologists when discussing individual risks with patients, since they are graphic and easy to explain."
Written by Petra Rattue
Copyright: Medical News Today
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Prof Heikki Joensuu et al.
The Lancet Oncology, Early Online Publication, 7 December 2011 doi:10.1016/S1470-2045(11)70299-6 Please use one of the following formats to cite this article in your essay, paper or report:
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8 Dec. 2011.
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