Significance of surgery for prognosis of gist in cohort from transitional healthcare settings

• Transitional economies face economic boundaries in rehearsing optimal level of care.
• Surgery bears relatively important position in treatment of GIST.
• Limited availability of chemotherapy influenced prognostic significance of surgery.
• Ki-67 being greater than 9% showed association with overall survival.

Objective: Despite significant improvement in survival of gastrointestinal stromal tumors (GIST) due to use of tyrosine kinase inhibitors, surgery still represents the important part of clinical management. The aim of our study was to retrospectively analyze prognosis of GIST depending on the success of surgical treatments and utilization of chemotherapy in transitional country with relatively limited resources. Methods: cohort of consecutive patients operated for GIST in tertiary medical center, within time frame 1999–2012. Results: 54 patients, in age range 20–85 years (63.3 ± 14.7), male to female ratio 28 (51.9%):26 (48.1%), respectively. Complete excision with clean resection margins (R0) was obtained in 44 (81.5%)of total patients i.e. 44/47 (93.6%) of localized GISTs. Mean follow up was 3.9 ± 3.3 years and 19 patients (35.2%) received imatinib. Rate of overall survival was 40 (74.1%), disease-free survival 31 (57.4%) and 20 (37.0%) experienced recidivism. Follow-up parameters showed significant difference in connection with utilization of imatinib, completeness of resection and existence of metastatic disease (all p < 0.05). ROC analyzes revealed critical value of Ki-67 > 9% as significant predictor of long-term mortality; sensitivity 64.3% [95%CI = 35.1–87.2]; specificity 75.0% [58.8–87.3]; (AUC = 0.693; p = 0.049). Conclusion: Rate of complete resections in studied sample of patients from transitional background was overall peer comparable with reports from the developed countries. On the other hand, relatively dominant prognostic position of surgical treatments might be consequence of limited utilization of adjuvant treatment with tyrosine kinase inhibitors.