Understanding Gastric GIST: From Pathophysiology to Personalized Treatment

Abstract

Background: Gastric gastrointestinal stromal tumors (GISTs) represent a subset of gastrointestinal tumors predominantly found in the stomach. Despite their rarity, these tumors carry significant implications for patient health and management. GISTs are potentially malignant tumors with unpredictable progression. They originate from the interstitial cells of Cajal, which are positioned between the intramural neurons and the smooth muscle cells of the digestive tract. These tumors are characterized primarily by mutations in the c-Kit gene, as well as other mutations such as those in the platelet-derived growth factor receptor alpha (PDGFRA) gene. Methods: Our comprehensive search across five databases initially yielded 2976 articles. After eliminating 197 duplicates, we screened the titles and abstracts of 2779 articles, excluding 2692 for not meeting the inclusion criteria. During the full-text screening, 16 more articles were excluded. Ultimately, 71 papers met the inclusion criteria and were included in our analysis. Results: Due to differences in study designs, inclusion criteria for patients, and reported outcomes, a meta-analysis was not conducted. The accurate diagnosis of GIST is established through histopathological examination and immunohistochemistry. Histopathologically, GISTs are classified into three main types: spindle cell, epithelioid, and mixed. The therapeutic management of GIST involves surgery, endoscopic treatment, and chemotherapy. Conclusions: The prognosis for GIST patients depends on various factors, including risk category, disease stage, applied treatments, and recurrence post-treatment. A significant recent advancement comes from artificial intelligence, which can be increasingly involved in both the diagnosis and treatment of this tumor.

Keywords: GIST; artificial intelligence; gastric; imaging; surgery.

Figure 1

Selection process of the articles included in the review.

Figure 2

(a) CT aspect of gastric GIST. (b) Wedge resection for an endophytic gastric GIST.

Figure 3

(a) Large gastric GIST. (B) Subtotal gastrectomy for large gastric GIST.

Figure 4

(a) Invasive gastric GIST in left hepatic lobe and diaphragm; tumor progression under Imatinib treatment; patient with severe obstructive symptoms. (b) Total gastrectomy, atypical left hepatic lobe resection, and debulking.