Prognostic factors affecting survival after surgical resection of gastrointestinal stromal tumours: a two-unit experience over 10 years

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract which has only been recently described based on their specific immunohistochemistry and the presence of particular KIT-related mutations which potentially make them targets for tyrosine kinase inhibition. METHODS: Sixty-one patients (29 M; 32 F, median age 60 years; range: 23–86 years) between June 1994 and March 2005, were analyzed from two allied institutions. Patient, tumour, and treatment variables were analyzed to identify factors affecting survival. RESULTS: Of the 61 patients, 55 (90%) underwent complete surgical resection of macroscopic disease. The 5-year overall survival (OS) rate in the 61 patients was 88% and the 5-year disease-free survival (DFS) in the 55 cases completely resected was 75%. Univariate analysis revealed that R0 resection was strongly associated with a better OSrate (p < 0.0001). Likewise, univariate analysis also showed high mitotic count of > 10 mitoses/per 50 HPF was a significant variable in worse prognosis for OS (≤ 10 mitoses/per 50 HPF 95% 5-year OS vs. > 10 mitoses/per 50 HPF 74% 5-year OS, respectively; p = 0.013). On subsequent multivariate analysis, only high mitotic count remained as a significant negative prognostic variable for OS (p = 0.029). Among patients resected for cure, there were 8 recurrences during follow-up. The mean time to recurrence was 21 ± 10 months (range: 4–36 months). Univariate analysis revealed that mitotic count of > 10 mitoses per 50 high power fields, intratumoural necrosis, and pathological tumour size (> 10 cm in maximal diameter) significantly correlated with DFS (p = 0.006, 0.002 and 0.02, respectively), with tumour necrosis and high mitotic count remaining as independent predictive variables affecting prognosis on subsequent multivariate analysis. CONCLUSION: Most GISTs are resectable with survival principally dependent upon mitotic count and completeness of resection. Future metabolic and genetic analyses will define the role of and resistance to induction or postoperative adjuvant targeted kinase inhibition therapy

SHOWCAVE: a multidisciplinary research project to quantify and mitigate the environmental impacts in tourist caves

Over the past decades, interest for the underground karst environments has grown remarkably, not only from the scientific viewpoint, but also from an economic perspective. The so-called “show caves” are caves open to the public for touristic purposes, managed by a governmental or commercial organization. The numbers of visitors (up to 500,000/year/cave) and the profits deriving from such activities have recently gained importance worldwide. The research project of relevant national interest (PRIN 2017) “SHOWCAVE”, aims at providing an in-depth characterization of the environmental impacts related to tourist exploitation in the major Italian show caves. During the first year of the project, 12 Italian show caves were chosen as ideal setting to develop the core of the research program, i.e. the multidisciplinary evaluation of tourism impacts based on a wide set of indicators, encompassing all the abiotic and biotic components. By adopting innovative techniques and original methods, the different research units are currently monitoring: i) physical indicators, namely water and air parameters; ii) geological indicators, such asthe alterations of the carbonate rocks; iii) biological indicators, including invertebrates, lampenflora and the microbiota; iv) palaeontological and archaeological indicators. Side researches are being performed on the contamination by lint, the description of the natural heritage of Italian show caves and the human perception of the tourism impacts in the subterranean environment. The development of the first LCA (Life Cycle Assessment) method to comprehensively evaluate the impacts of the touristic service offered by show caves, together with a review of available literature on show caves, are also being carried out. Preliminary results have already been disseminated in several public engagement and educational activities. At the end, the results obtained by all the research activities will be combined to develop general protection measures and provide specific suggestions for the sustainable use of show caves