{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:49:07Z","timestamp":1790981347783,"version":"4.1.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi231206-4\"><jats:title>Importance<\/jats:title><jats:p>Gastrointestinal stromal tumor (GIST) follow-up is recommended by international guidelines, but data on the role of follow-up in patients with low relapse risk are missing. For these patients, the potential benefit of anticipating recurrence detection should be weighed against psychological burden and radiologic examination loads in terms of costs and radiation exposure.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the outcomes of guideline-based follow-up in low-risk GIST.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This multi-institutional retrospective cohort study involving Italian Sarcoma Group reference institutions evaluated patients with GIST who underwent surgery between January 2001 and June 2019. Median follow-up time was 69.2 months. Data analysis was performed from December 15, 2022, to March 20, 2023. Patients with GIST at low risk according to Armed Forces Institute of Pathology criteria were included provided adequate clinical information was available: primary site, size, mitotic index, surgical margins, and 2 or more years of follow-up.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-7\"><jats:title>Exposures<\/jats:title><jats:p>All patients underwent follow-up according to European Society for Medical Oncology (ESMO) guidelines.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was the number of tests needed to identify a relapse according to ESMO guidelines follow-up plan. Secondary outcomes included relapse rate, relapse timing, disease-free survival (DFS), overall survival (OS), GIST-specific survival (GIST-SS), postrelapse OS, secondary tumor rates, and theoretical ionizing radiation exposure. An exploratory end point, new follow-up schedule proposal for patients with low-risk GIST according to the observed results, was also assessed.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-9\"><jats:title>Results<\/jats:title><jats:p>A total of 737 patients (377 men [51.2%]; median age at diagnosis, 63 [range, 18-86] years) with low-risk GIST were included. Estimated 5-year survival rates were 95.5% for DFS, 99.8% for GIST-SS, and 96.1% for OS. Estimated 10-year survival rates were 93.4% for DFS, 98.1% for GIST-SS, and 91.0% for OS. Forty-two patients (5.7%) experienced disease relapse during follow-up (9 local, 31 distant, 2 both), of which 9 were detected after 10 or more years. This translated into approximately 1 relapse detected for every 170 computed tomography scans performed, with a median radiation exposure of 80 (IQR, 32-112) mSv per patient. Nongastric primary tumor (hazard ratio [HR], 2.09; 95% CI, 1.14-3.83;<jats:italic>P<\/jats:italic>\u2009=\u2009.02), and<jats:italic>KIT<\/jats:italic>mutation (HR, 2.77; 95% CI, 1.05-7.27;<jats:italic>P<\/jats:italic>\u2009=\u2009.04) were associated with a higher risk of relapse. Second tumors affected 187 of 737 patients (25%), of which 56 were detected during follow-up and represented the primary cause of death in these patients.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231206-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study on patients affected by low-risk GISTs, the risk of relapse was low despite a follow-up across 10 or more years. These data suggest the need to revise follow-up schedules to reduce the anxiety, costs, and radiation exposure of currently recommended follow-up strategy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.41522","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T16:01:31Z","timestamp":1699286491000},"page":"e2341522","source":"Crossref","is-referenced-by-count":9,"title":["Guideline-Based Follow-Up Outcomes in Patients With Gastrointestinal Stromal Tumor With Low Risk of Recurrence"],"prefix":"10.1001","volume":"6","author":[{"given":"Lorenzo","family":"D\u2019Ambrosio","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, University of Turin, Turin, Italy"},{"name":"San Luigi Gonzaga University Hospital, Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Fumagalli","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso Martino","family":"De Pas","sequence":"additional","affiliation":[{"name":"Medical Oncology Division, Cliniche Humanitas Gavazzeni, Bergamo, Italy"},{"name":"Previously at Unit of Sarcomas and Thymomas, European Institute of Oncology, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Nannini","sequence":"additional","affiliation":[{"name":"Oncology Unit. 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