Prognostički čimbenici u gastrointestinalnim stromalnim tumorima

master's thesis

• Title (english): Prognostic factors of gastrointestinal stromal tumors
• Author: Gordan Adžić
• Mentor: Borislav Belev (mentor)
• Committee member: Damir Vrbanec (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Borislav Belev (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pathophysiology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pathophysiology

Abstract

Gastrointestinalni stromalni tumori (GIST) najčešće su mezenhimske neoplazme probavnog sustava. Smatra se da GIST potječe od Cajalovih intersticijskih stanica ili od zajedničkog prekursora. Najčešće se javlja u želudcu i tankom crijevu, a jedna od glavnih karakteristika GIST-a je posjedovanje mutacija u KIT ili PDGFRA genu. Znanstveni napredak u razumijevanju stanične biologije ovog tumora je GIST učinio paradigmom uspješne ciljane molekularne terapije. GIST-ovi su klinički i morfološki vrlo heterogena skupina tumora sa biološkim ponašanjem koje varira od benignih oblika do izrazito malignih sarkoma. Jedan od glavnih problema u zbrinjavanju pacijenata s GIST-om je činjenica da gotovo svi imaju maligni potencijal, zbog čega je razvoj prognostičkih modela radi stratifikacije rizika od ključnog značaja. Najvažniji negativni nezavisni prognostički čimbenici GIST-a su mitotski indeks te veličina, sijelo i ruptura tumora. Na temelju navedenih čimbenika razvijeni su prognostički modeli koji stratificiraju pacijente prema riziku za povrat bolesti u nisko rizične, srednje rizične i visoko rizične skupine, od kojih su najvažniji NIH model, modificirani NIH model te AFIP model. Pacijenti koji spadaju u visoko rizičnu skupinu su kandidati za adjuvantnu primjenu imatiniba. Uz prognostičke modele, razvijeni su razni nomogrami i konturne karte čija je svrha individualizirana procjena rizika za povrat bolesti. Iako svi navedeni modeli relativno dobro predviđaju pacijente s visokim rizikom za povrat bolesti, sposobnost diskriminacije između nisko rizičnih i srednje rizičnih pacijenata relativno je slaba. Zbog toga su potrebna daljnja istraživanja prognostičkih čimbenika kao i unaprjeđenje trenutnih prognostičkih modela i nomograma radi boljeg selekcioniranja pacijenata koji su kandidati za adjuvantnu primjenu imatiniba.

Abstract (english)

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They originate or share a common stem cell with the interstitial Cells of Cajal. They most commonly arise in the stomach or in the small intestine and one of their main characteristics is having a mutation in KIT or PDGFRA gene. Scientific advancement in understanding of their cell biology has made this tumor a paradigm for successful molecularly targeted therapy. GISTs are clinically and morphologically very heterogeneous group of tumors. Their biological behavior ranges from benign lesions to overtly malignant sarcomas. One of the main issues in the management of patients with GISTs is the fact that almost every tumor has malignant potential and that makes the development of prognostic models for risk stratification highly important. The most important negative independent prognostic factors are mitotic rate, tumor size, location, and rupture. They served as a basis for development of prognostic models which stratify patients according to risk for disease recurrence to low risk, intermediate risk and high-risk groups. The most important prognostic models are NIH model, modified NIH model and AFIP model. Patients who are stratified into high-risk group are candidates for adjuvant imatinib therapy. Along with prognostic models, various nomograms and contour maps were developed. Their purpose is individualized risk assessment. Although all models perform good in discrimination of high risk patients, their discriminatory ability in low risk and intermediate risk group is unsatisfactory. Further research is needed to determine the value of specific prognostic factors and to improve current prognostic models which will enable better selection of candidates for adjuvant imatinib therapy.

• Keywords: gastrointestinalni stromalni tumori; prognostički čimbenici; prognostički modeli; nomogrami
• Keywords (english): gastrointestinal stromal tumors; prognostic factors; prognostic models; nomograms
• Language: croatian
• URN:NBN: urn:nbn:hr:105:380630
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-27 08:56:06