Gastrointestinal Stromal Tumors (GISTs) Staging 

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Gastrointestinal Stromal Tumors (GISTs) Staging 

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The American Joint Committee on Cancer tumor/node/metastasis (TNM) classification for gastrointestinal stromal tumors (GISTs) is provided below, along with anatomic stage/prognostic groups. [1]

Table 1. TNM classification of gastrointestinal stromal tumors (Open Table in a new window)

Primary tumor (T)

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 2 cm

T2

Tumor > 2 cm but ≤ 5 cm

T3

Tumor > 5 cm but ≤ 10 cm

T4

Tumor > 10 cm in greatest dimension

Regional lymph nodes (N)

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Table 2. Histologic grade (Open Table in a new window)

Histologic grade (G)

GX

Grade cannot be assessed

G1

Low grade; mitotic rate 5/50 per high-power field (HPF) or less

G2

High grade; mitotic rate > 5/50 HPF

 

Table 3. Anatomic stage/prognostic groups for gastric and omental GISTs (Open Table in a new window)

Stage

T

N

M

Mitotic rate

IA

T1 or T2

N0

M0

Low mitotic rate

IB

T3

N0

M0

Low mitotic rate

II

T1

N0

M0

High mitotic rate

T2

N0

M0

High mitotic rate

T4

N0

M0

Low mitotic rate

IIIA

T3

N0

M0

High mitotic rate

IIIB

T4

N0

M0

High mitotic rate

IV

Any T

N1

M0

Any rate

Any T

Any N

M1

Any rate

Table 4. Anatomic stage/prognostic groups for small intestinal, esophageal, colorectal, mesentric, and peritoneal GISTs (Open Table in a new window)

Stage

T

N

M

Mitotic rate

I

T1 or T2

N0

M0

Low mitotic rate

II

T3

N0

M0

Low mitotic rate

IIIA

T1

N0

M0

High mitotic rate

T4

N0

M0

Low mitotic rate

IIIB

T2

N0

M0

High mitotic rate

T3

N0

M0

High mitotic rate

T4

N0

M0

High mitotic rate

IV

Any T

N1

M0

Any rate

Any T

Any N

M1

Any rate

The decision whether to pursue adjuvant treatment depends on an estimation of risk of recurrence, which is typically based on the following factors [2, 3] :

Table 5. Modified National Institutes of Health risk stratification criteria for GIST

Table. (Open Table in a new window)

 

American Joint Committee on Cancer. Gastrointestinal Stromal Tumor. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. AJCC Cancer Staging Manual. 8th edition. New York, NY: Springer; 2016. 226-232. [Full Text].

Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Path. 2002 Apr 01. 10 (2):81-89. [Medline]. [Full Text].

Huang HY, Li CF, Huang WW, et al. A modification of NIH consensus criteria to better distinguish the highly lethal subset of primary localized gastrointestinal stromal tumors: a subdivision of the original high-risk group on the basis of outcome. Surgery. 2007 may 04. 141 (6):748-756. [Medline]. [Full Text].

Primary tumor (T)

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 2 cm

T2

Tumor > 2 cm but ≤ 5 cm

T3

Tumor > 5 cm but ≤ 10 cm

T4

Tumor > 10 cm in greatest dimension

Regional lymph nodes (N)

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Histologic grade (G)

GX

Grade cannot be assessed

G1

Low grade; mitotic rate 5/50 per high-power field (HPF) or less

G2

High grade; mitotic rate > 5/50 HPF

Stage

T

N

M

Mitotic rate

IA

T1 or T2

N0

M0

Low mitotic rate

IB

T3

N0

M0

Low mitotic rate

II

T1

N0

M0

High mitotic rate

T2

N0

M0

High mitotic rate

T4

N0

M0

Low mitotic rate

IIIA

T3

N0

M0

High mitotic rate

IIIB

T4

N0

M0

High mitotic rate

IV

Any T

N1

M0

Any rate

Any T

Any N

M1

Any rate

Stage

T

N

M

Mitotic rate

I

T1 or T2

N0

M0

Low mitotic rate

II

T3

N0

M0

Low mitotic rate

IIIA

T1

N0

M0

High mitotic rate

T4

N0

M0

Low mitotic rate

IIIB

T2

N0

M0

High mitotic rate

T3

N0

M0

High mitotic rate

T4

N0

M0

High mitotic rate

IV

Any T

N1

M0

Any rate

Any T

Any N

M1

Any rate

Shamudheen Rafiyath, MD Hematologist/Oncologist, Arizona Oncology

Shamudheen Rafiyath, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Terence D Rhodes, MD, PhD Medical Oncologist, Intermountain Medical Group

Terence D Rhodes, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Gastrointestinal Stromal Tumors (GISTs) Staging 

Research & References of Gastrointestinal Stromal Tumors (GISTs) Staging |A&C Accounting And Tax Services
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