Prognostic value of tumor necrosis in gastrointestinal stromal tumor A meta-analysis

Background and aims: There is currently no consensus regarding the influence of tumor necrosis on the prognosis of gastrointestinal stromal tumors (GISTs). Therefore, we conducted a meta-analysis to determine the prognostic role of tumor necrosis in patients with GIST. Methods: PubMed, Embase, and Web of Science electronic databases were searched from their inception to March 2018. Studies reporting data on the relationship between tumor necrosis and GIST prognosis were eligible. The measure of the effect of interest was the odds ratios (ORs) with 95% confidence intervals (CIs). This study has been registered in the Prospero (number CRD42018096036). Results: In total, 18 studies including 2320 patients were identified. The total odds of tumor necrosis were associated with a poor GIST prognosis (OR=5.54, 95% CI=4.39-6.99). Subgroup analysis of different observed outcomes indicated that tumor necrosis was associated with a decreased disease-free survival (OR=7.08, 95% CI=4.78-10.49), recurrence-free survival (OR=3.96, 95% CI=2.48-6.32), and overall survival (OR=4.29, 95% CI=2.02-9.13). In addition, any tumor site, tumor size, follow-up time, ethnicity, different outcomes of GIST, and different degrees of positive staining of immunohistochemical markers subgroups showed a significantly increased risk of a poor prognosis. Conclusions: Tumor necrosis may likely predict a poorer prognosis for GIST. However, further well-designed prospective studies with large sample size are required in the future.