Prognostic factors and management of colorectal gastrointestinal stromal tumours

Abstract

Introduction: Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Even though it can be found in any location of the digestive tract, colorectal GIST is a rare entity. With this study, we aim to review the current knowledge regarding colorectal GIST prognosis and management. Methods: A literature search was conducted in PubMed and 717 articles were collected. After analysis of these studies, 60 articles were selected to use in this review. Results: Mitotic index, tumour size and location were identified as good discriminators of prognosis in various studies. Surgery remains the only curative therapy for potentially resectable tumours. However, even after surgery, some patients develop disease recurrence and metastasis, especially those with high-risk tumours. Therefore, surgery alone might be inadequate for GIST management. The discovery of GIST's molecular pathway led to a paradigm shift in its therapy, insofar tyrosine kinase inhibitors became part of treatment schemes for this tumour, revolutionising patients' outcome and prognosis. Discussion/Conclusion: Some controversy concerning colorectal GIST prognosis and treatment exists, which can be attributed in part to the limited number of studies in the literature. In this review we gather the most recent knowledge about prognosis and management of GIST in this rare location and propose two algorithms for its approach. Lastly, we highlight the importance of an individualised patient approach in the setting of a multidisciplinary team.