Prognostic impact of positive microscopic margins (R1 resection) in patients with GIST (gastrointestinal stromal tumours): Results of a multicenter European study - Archive ouverte HAL Access content directly
Journal Articles EJSO - European Journal of Surgical Oncology Year : 2024

Prognostic impact of positive microscopic margins (R1 resection) in patients with GIST (gastrointestinal stromal tumours): Results of a multicenter European study

1 Hôpital Claude Huriez [Lille]
2 Centre Hospitalier de Seclin
3 CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
4 CHU Cambrai
5 Institut Pasteur de Lille
6 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
7 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
8 CHU Saint-Antoine [AP-HP]
9 SU - Sorbonne Université
10 UB - Université de Bordeaux
11 CHU Bordeaux
12 IMM - Institut Mutualiste de Montsouris
13 Hôpital de la Croix-Rousse [CHU - HCL]
14 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
15 Chirurgie digestive [CHU Amiens]
16 IGR - Institut Gustave Roussy
17 UniBs - Università degli Studi di Brescia = University of Brescia
18 Hôpital Dupuytren [CHU Limoges]
19 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
20 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
21 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
22 Institut Curie [Paris]
23 Clinique Hartmann [Neuilly-sur-Seine]
24 Nutriomics - Nutrition et obésités: approches systémiques (UMR-S 1269)
25 CHU Pitié-Salpêtrière [AP-HP]
26 l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)
27 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
28 NuMeCan - Nutrition, Métabolismes et Cancer
29 Hôpital de la Cavale Blanche
30 Centre Hospitalier Universitaire [Rennes]
31 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
32 Hôpital de Hautepierre [Strasbourg]
Caroline Gronnier
Leonor Benhaim
Muriel Mathonnet
Olivier Glehen
Pascale Mariani
Yves Panis
Cécile Brigand
  • Function : Author
  • PersonId : 1044626


Background Although several prognostic factors in GIST have been well studied such as tumour size, mitotic rate, or localization, the influence of microscopic margins or R1 resection remains controversial. The aim of this study was to evaluate the influence of R1 resection on the prognosis of GIST in a large multicentre retrospective series of patients. Methods From 2001 to 2013, 1413 patients who underwent surgery for any site of GIST were identified from 61 European centres. 1098 patients were included, excluding synchronous metastases, concurrent malignancies, R2 resection or GIST recurrence. Tumour rupture (TR) was reclassified according to the Oslo sarcoma classification. Cox proportional hazards ratio and Kaplan-Meier survival estimates were used to analyse 5-year recurrence-free survival (RFS). Results Of 1098 patients, 38 (3%) underwent R1 resection with a risk of TR of 11%. The 5-year RFS was 89.6% with a median follow-up of 81 months [range: 31.2–152 months]. On univariate analysis, lower RFS was significantly associated with R1 resection [HR = 2.13; p = 0.04], high risk score according to the modified NIH classification, administration of adjuvant therapy [HR = 2.24; p < 0.001] and intraoperative complications [HR = 2.82; p < 0.001]. Only intraoperative complications [HR = 1.79; p = 0.02] and high risk according to the modified NIH classification including the updated definition of TR [HR = 3.43; p = 0.04] remained significant on multivariate analysis. Conclusion This study shows that positive microscopic margins are not an independent predictive factor for RFS in GIST when taking into account the up-dated classification of TR. R1 resection may be considered a reasonable alternative to avoid major functional sequelae and should not lead to reoperation.
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Saturday, September 28, 2024
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hal-04529411 , version 1 (30-05-2024)




Flore Thibaut, Julie Veziant, Maxime Warlaumont, Victoria Gauthier, Jeremie Lefèvre, et al.. Prognostic impact of positive microscopic margins (R1 resection) in patients with GIST (gastrointestinal stromal tumours): Results of a multicenter European study. EJSO - European Journal of Surgical Oncology, 2024, 50 (6), pp.108310. ⟨10.1016/j.ejso.2024.108310⟩. ⟨hal-04529411⟩
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