Hamda Almaazmi1, Miloslawa Stem1, Brian D Lo1, James P Taylor1, Sandy H Fang1, Bashar Safar1, Jonathan E Efron1, Chady Atallah2. 1. Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA. 2. Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA. catalla3@jhmi.edu.
Abstract
BACKGROUND: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. METHODS: Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004-2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS: A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009-2015: adjusted HR [AHR] 0.73, 95% CI 0.59-0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19-1.53; 10-year AHR 1.23, 95% CI 1.09-1.38; each p < 0.001). CONCLUSION: CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.
BACKGROUND: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. METHODS:Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004-2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS: A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009-2015: adjusted HR [AHR] 0.73, 95% CI 0.59-0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19-1.53; 10-year AHR 1.23, 95% CI 1.09-1.38; each p < 0.001). CONCLUSION:CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.
Entities:
Keywords:
Chemotherapy; Colorectal; GIST; Gastrointestinal stromal tumor; Imatinib; Small bowel
Authors: Ronald P DeMatteo; Karla V Ballman; Cristina R Antonescu; Christopher Corless; Violetta Kolesnikova; Margaret von Mehren; Martin D McCarter; Jeffrey Norton; Robert G Maki; Peter W T Pisters; George D Demetri; Murray F Brennan; Kouros Owzar Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: Fabian M Johnston; Peter J Kneuertz; John L Cameron; Dominic Sanford; Sarah Fisher; Ryan Turley; Ryan Groeschl; Omar Hyder; David A Kooby; Dan Blazer; Michael A Choti; Christopher L Wolfgang; T Clark Gamblin; William G Hawkins; Shishir K Maithel; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2012-08-10 Impact factor: 5.344
Authors: Heikki Joensuu; Aki Vehtari; Jaakko Riihimäki; Toshirou Nishida; Sonja E Steigen; Peter Brabec; Lukas Plank; Bengt Nilsson; Claudia Cirilli; Chiara Braconi; Andrea Bordoni; Magnus K Magnusson; Zdenek Linke; Jozef Sufliarsky; Massimo Federico; Jon G Jonasson; Angelo Paolo Dei Tos; Piotr Rutkowski Journal: Lancet Oncol Date: 2011-12-06 Impact factor: 41.316
Authors: C Colombo; U Ronellenfitsch; Z Yuxin; P Rutkowski; R Miceli; E Bylina; P Hohenberger; C P Raut; A Gronchi Journal: Ann Surg Oncol Date: 2012-07-28 Impact factor: 5.344
Authors: Gustavo dos Santos Fernandes; Charles D Blanke; Daniela Freitas; Rodrigo Guedes; Paulo M Hoff Journal: Oncology (Williston Park) Date: 2009-01 Impact factor: 2.990
Authors: Fabiola Medeiros; Christopher L Corless; Anette Duensing; Jason L Hornick; Andre M Oliveira; Michael C Heinrich; Jonathan A Fletcher; Christopher D M Fletcher Journal: Am J Surg Pathol Date: 2004-07 Impact factor: 6.394
Authors: Peter C Wu; Alex Langerman; Christopher W Ryan; John Hart; Susan Swiger; Mitchell C Posner Journal: Surgery Date: 2003-10 Impact factor: 3.982