Impact of a Modified Fletcher Classification System for Gastrointestinal Stromal Tumors: a Single-center Retrospective Analysis

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  • Yamamoto Takehito
    Department of Surgery, Kobe City Medical Center General Hospital
  • Miki Akira
    Department of Surgery, Kobe City Medical Center General Hospital
  • Okada Kazuyuki
    Department of Surgery, Kobe City Medical Center General Hospital
  • Ichikawa Chihiro
    Department of Clinical Pathology, Kobe City Medical Center General Hospital
  • Matsuoka Ryosuke
    Department of Clinical Pathology, Kobe City Medical Center General Hospital
  • Uehara Keiichiro
    Department of Clinical Pathology, Kobe City Medical Center General Hospital
  • Kaihara Satoshi
    Department of Surgery, Kobe City Medical Center General Hospital
  • Hosotani Ryo
    Department of Surgery, Kobe City Medical Center General Hospital

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  • 消化管間葉系腫瘍の術後再発危険因子とmodified Fletcher分類によるリスク分類の有用性の検討

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Purpose: Several risk classifications for gastrointestinal stromal tumors (GIST) have been reported. We analyzed the clinicopathological characteristics of patients with GIST and the feasibility of a modified Fletcher classification system. Methods: We analyzed 40 patients with GIST who underwent surgical resection in our hospital between January 2008 and October 2013. We analyzed risk factors for recurrence and compared the recurrence rate and recurrence-free survival (RFS) time among risk groups according to 3 risk classification systems: the Fletcher classification, the Miettinen classification, and the modified Fletcher classification. Results: Twenty-six patients consisted of 12 men and 14 women. The mean age was 64 years. Tumors were found in the esophagus (1 patient), stomach (26 patients), duodenum (4 patients), and intestine (9 patients). Patients were assigned to 4 groups (very low, 5; low, 10; moderate, 4; and high-risk, 21) in accordance with the modified Fletcher classification, respectively. Four patients had recurrence, and only in the modified Fletcher classification was the recurrence rate significantly higher in the high-risk group than in other groups (19.0% vs. 0% P=0.018). There was also a tendency for the 3-year RFS to be lower in the high-risk group than in other groups (75.7% vs. 100% P=0.094). Conclusion: Classifying patients with GIST in accordance with the modified Fletcher classification is reasonable when selecting patients who should be treated by adjuvant chemotherapy.

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