Comparing the long-term outcomes among patients with stomach and small intestine gastrointestinal stromal tumors: An analysis of the National Cancer Database.

Published on Sep 1, 2018in Journal of Surgical Oncology2.771
· DOI :10.1002/JSO.25172
Katherine Giuliano8
Estimated H-index: 8
(JHUSOM: Johns Hopkins University School of Medicine),
Aslam Ejaz34
Estimated H-index: 34
(JHUSOM: Johns Hopkins University School of Medicine)
+ 5 AuthorsNita Ahuja63
Estimated H-index: 63
(Yale University)
Sources
Abstract
BACKGROUND AND OBJECTIVES: Gastrointestinal stromal tumors (GIST) are the most common sarcoma arising from the gastrointestinal tract. Data regrading long-term prognosis based on tumor location (stomach vs small intestine) are mixed, so we aimed to analyze their outcomes using a large national oncology database. METHODS: The National Cancer Database was queried for cases of stomach and small intestine GIST between the years 2004 and 2014. Survival analysis was performed using the Kaplan-Meier method, and factors related to survival were compared using the Cox proportional hazards model. RESULTS: Of 18 900 total patients, those with small intestine GIST had larger median tumor size (6.2 cm; interquartile range [IQR], 3.8 to 10.0 vs stomach: 5.0 cm; IQR, 3.0 to 9.0; P < 0.001) and a higher incidence of tumors with ≥5 mitoses/50 HPF (29.3% vs stomach: 24.2%; P < 0.001). Unadjusted median overall survival (OS) was longer for patients with stomach GIST (10.3 years) as compared to small intestine GIST (9.4 years) (P = 0.01). After controlling for patient and tumor-related factors, however, OS did not differ between stomach and small intestine GIST (hazard ratio, 1.19; 95% confidence interval, 0.88 to 1.61; P = 0.26). CONCLUSIONS: Patients with small intestine GIST more commonly have larger, high mitotic rate tumors, but despite these worse prognostic features, tumor location did not independently impact OS.
📖 Papers frequently viewed together
10 Authors (Wenze Wan, ..., Kaixiong Tao)
5 Citations
3 Citations
References28
Newest
#1Daniel J. Boffa (Yale University)H-Index: 33
#2Joshua E. Rosen (Yale University)H-Index: 15
Last. David P. Winchester (ACS: American College of Surgeons)H-Index: 70
view all 11 authors...
Importance The National Cancer Database (NCDB), a joint quality improvement initiative of the American College of Surgeons Commission on Cancer and the American Cancer Society, has created a shared research file that has changed the study of cancer care in the United States. A thorough understanding of the nuances, strengths, and limitations of the database by both readers and investigators is of critical importance. This review describes the use of the NCDB to study cancer care, with a focus on...
420 CitationsSource
#1Katherine Giuliano (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 8
#2Neeraja Nagarajan (Brigham and Women's Hospital)H-Index: 15
Last. Nita Ahuja (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 63
view all 10 authors...
Background and Objectives Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Previous literature has suggested that small intestine GISTs are more aggressive than gastric GISTs. Our primary objective was to compare the outcomes of gastric and small intestine GISTs in the decade after approval of imatinib for treatment. Methods The SEER database was queried for cases of gastric and small intestine GIST between the years 2002 and 2012, usi...
25 CitationsSource
#1Ulrich Güller (University of Bern)H-Index: 19
#1Ulrich Güller (University of Bern)H-Index: 4
Last. Rene Warschkow (Heidelberg University)H-Index: 23
view all 6 authors...
Background The objective of the present analysis was to assess whether small bowel gastrointestinal stromal tumor (GIST) is associated with worse cancer-specific survival (CSS) and overall survival (OS) compared with gastric GIST on a population-based level.
16 CitationsSource
#1Grace L. Ma (UCSD: University of California, San Diego)H-Index: 4
#2James D. Murphy (UCSD: University of California, San Diego)H-Index: 37
Last. Jason K. Sicklick (UCSD: University of California, San Diego)H-Index: 33
view all 4 authors...
To date, all population-based epidemiologic data on gastrointestinal stromal tumor (GIST) in the United States predate the 2001 implementation of GIST-specific histology coding. As such, results from previous studies were limited due to inclusion of non-GIST abdominal or gastrointestinal sarcomas. We utilized a national cancer registry with modern day histological codes to gain greater insight into the true epidemiology of GIST in the United States. We identified 6,142 patients diagnosed with GI...
125 CitationsSource
#1Melissa M. Murphy (UMMS: University of Massachusetts Medical School)H-Index: 10
#2Karim Alavi (UMMS: University of Massachusetts Medical School)H-Index: 21
Last. Justin A. Maykel (UMMS: University of Massachusetts Medical School)H-Index: 24
view all 3 authors...
Outcomes research has established itself as an integral part of surgical research as physicians and hospitals are increasingly required to demonstrate attainment of performance markers and surgical safety indicators. Large-volume and clinical and administrative databases are used to study regional practice pattern variations, health care disparities, and resource utilization. Understanding the unique strengths and limitations of these large databases is critical to performing quality surgical ou...
40 CitationsSource
#1Margaret von Mehren (Fox Chase Cancer Center)H-Index: 59
#2Robert S. Benjamin (University of Texas MD Anderson Cancer Center)H-Index: 96
Last. Nicole R. McMillianH-Index: 33
view all 28 authors...
: The major changes to the 2012 and 2011 NCCN Guidelines for Soft Tissue Sarcoma pertain to the management of patients with gastrointestinal stromal tumors (GISTs) and desmoid tumors (aggressive fibromatosis). Postoperative imatinib following complete resection for primary GIST with no preoperative imatinib is now included as a category 1 recommendation for patients with intermediate or high risk of recurrence. The panel also reaffirmed the recommendation for preoperative use of imatinib in pati...
120 CitationsSource
#1Heikki Joensuu (UH: University of Helsinki)H-Index: 120
#2Mikael ErikssonH-Index: 70
Last. Peter ReichardtH-Index: 61
view all 23 authors...
Context Adjuvant imatinib administered for 12 months after surgery has improved recurrence-free survival (RFS) of patients with operable gastrointestinal stromal tumor (GIST) compared with placebo. Objective To investigate the role of imatinib administration duration as adjuvant treatment of patients who have a high estimated risk for GIST recurrence after surgery. Design, Setting, and Patients Patients with KIT-positive GIST removed at surgery were entered between February 2004 and September 20...
669 CitationsSource
#1Axel Le Cesne (Institut Gustave Roussy)H-Index: 75
#1Axel Le Cesne (Institut Gustave Roussy)H-Index: 42
Last. Jean-Yves Blay (French Institute of Health and Medical Research)H-Index: 110
view all 14 authors...
Summary Background The effect of imatinib discontinuation on progression-free survival and overall survival in long-lasting responders with advanced gastrointestinal stromal tumours (GIST) is unknown. We assessed treatment interruption in patients with non-progressive disease according to the Response Evaluation Criteria In Solid Tumors criteria after 3 years of imatinib in a randomised trial. Methods In this open-label national multicentre phase 3 study in France, patients with GIST free of pro...
207 CitationsSource
#1George D. Demetri (Harvard University)H-Index: 130
#2Margaret von MehrenH-Index: 59
Last. Jeffrey D. WayneH-Index: 31
view all 13 authors...
The standard of care for managing patients with gastrointestinal stromal tumors (GISTs) rapidly changed after the introduction of effective molecularly targeted therapies involving tyrosine kinase inhibitors (TKIs), such as imatinib mesylate and sunitinib malate. A better understanding of the molecular characteristics of GISTs have improved the diagnostic accuracy and led to the discovery of novel immunomarkers and new mechanisms of resistance to TKI therapy, which in turn have resulted in the d...
737 CitationsSource
#1Jason S. Gold (Brigham and Women's Hospital)H-Index: 27
#2Mithat Gonen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 139
Last. Ronald P. DeMatteo (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 127
view all 12 authors...
Summary Background Adjuvant imatinib mesylate prolongs recurrence-free survival (RFS) after resection of localised primary gastrointestinal stromal tumours (GIST). We aimed to develop a nomogram to predict RFS after surgery in the absence of adjuvant therapy to help guide patient selection for adjuvant imatinib therapy. Methods A nomogram to predict RFS based on tumour size (cm), location (stomach, small intestine, colon/rectum, or other), and mitotic index ( Findings The nomogram had a concorda...
333 CitationsSource
Cited By6
Newest
#1Huolun Feng (Southern Medical University)
#1Huolun Feng (Southern Medical University)
Last. Yong Li (Southern Medical University)H-Index: 1
view all 7 authors...
Abstract Background Thus far, the association of tumor size with prognosis in colon cancer has not been considered and has remained unclear. This study, therefore, aimed to investigate the association between tumor size as a continuous variable and prognosis in colon cancer using Cox models with restricted cubic splines. Methods Using the Surveillance, Epidemiology, and End Results database, we selected 128,369 patients with colon cancer who underwent surgery. Overall survival and colon cancer-s...
1 CitationsSource
BACKGROUND Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. METHODS We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January ...
Source
#1Si Zhao (Nanjing Medical University)H-Index: 1
#2Hanlong Zhu (Nanjing Medical University)H-Index: 1
Last. Guozhong Ji (Nanjing Medical University)H-Index: 25
view all 6 authors...
Background: Surgery has been the primary treatment in patients with localized gastrointestinal stromal tumors (GISTs) for many decades, whereas it remains controversial regarding the efficacy of primary tumor resection for metastatic GISTs treated with chemotherapy, and likewise it is unclear who would benefit from the surgical resection. Methods: GISTs patients with distant metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. Cox...
Source
#1Fangxing Peng (North Sichuan Medical College)
#2Yao Liu (North Sichuan Medical College)
In recent years, the diagnosis and treatment of gastrointestinal stromal tumors (GISTs) of the small intestine have been a hot topic due to their rarity and non-specific clinical manifestations. With the development of gene and imaging technology, surgery, and molecular targeted drugs, the diagnosis and treatment of GISTs have achieved great success. For a long time, radical resection was prioritized to treat GISTs of the small intestine. At present, preoperative tumor staging is a novel treatme...
1 CitationsSource
#1Jorge Florindez (SHM: Society of Hospital Medicine)H-Index: 1
#2Jonathan C. Trent (UM: University of Miami)H-Index: 23
OBJECTIVE: The objective of this study was to determine whether there were survival differences associated with KIT mutation testing, type of KIT mutations, and other clinical variables in patients with localized or metastatic gastrointestinal tumor (GIST). METHODS: Adult patients with GIST were extracted from the Surveillance Epidemiology and End Results (SEER) database from 2010 to 2015 with follow-up through 2016. Overall survival (OS) and cancer-specific survival (CSS) were the designated en...
3 CitationsSource
#1Zhiqiang Liu (HUST: Huazhong University of Science and Technology)H-Index: 7
#2Yan Sun (HUST: Huazhong University of Science and Technology)H-Index: 3
Last. Heshui Wu (HUST: Huazhong University of Science and Technology)H-Index: 17
view all 7 authors...
Objectives. The incidence of gastrointestinal stromal tumors (GISTs) located in the colon is rare. Current studies mainly focus on case reports for colonic GISTs. Therefore, a population-based analysis was useful to guide the clinical treatment strategy. Methods. The patients were selected from 2000 to 2015 based on Surveillance, Epidemiology, and End Results (SEER) database. Patients’ demographics, tumor characteristics, incidence, treatment, and survival were retrieved for analysis. Results. 2...
3 CitationsSource