Nikki S IJzerman1, Mahmoud Mohammadi2, Dimitri Tzanis3, Hans Gelderblom4, Marco Fiore5, Elena Fumagalli6, Piotr Rutkowski7, Elzbieta Bylina8, Ioannis Zavrakidis9, Neeltje Steeghs10, Han J Bonenkamp11, Boudewijn van Etten12, Dirk J Grünhagen13, Shahnawaz Rasheed14, Paris Tekkis15, Charles Honoré16, Winan van Houdt17, Jos van der Hage18, Sylvie Bonvalot19, Yvonne Schrage20, Myles Smith21. 1. Sarcoma Unit, Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: n.ijzerman@nki.nl. 2. Leiden University Medical Center, Department of Medical Oncology, Leiden, the Netherlands. Electronic address: m.mohammadi@lumc.nl. 3. Department of Surgery, Institut Curie, PSL University, Paris, France(2). Electronic address: dimitri.tzanis@curie.fr. 4. Leiden University Medical Center, Department of Medical Oncology, Leiden, the Netherlands. Electronic address: a.j.gelderblom@lumc.nl. 5. Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Surgery, Milano, Italy. Electronic address: marco.fiore@istitutotumori.mi.it. 6. Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Milano, Italy. Electronic address: elena.fumagalli@istitutotumori.mi.it. 7. Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland. Electronic address: piotr.rutkowski@coi.pl. 8. Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland. Electronic address: elab@coi.waw.pl. 9. Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands. Electronic address: izavrakidis@mail.com. 10. Sarcoma Unit, Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: n.steeghs@nki.nl. 11. Radboud University Medical Centre, Department of Surgical Oncology, Nijmegen, the Netherlands. Electronic address: han.bonenkamp@radboudumc.nl. 12. University of Groningen, University Medical Centre Groningen, Department of Surgery, Groningen, the Netherlands. Electronic address: b.van.etten@umcg.nl. 13. Erasmus MC - Cancer Institute, Department of Surgical Oncology, Rotterdam, the Netherlands. Electronic address: d.grunhagen@erasmusmc.nl. 14. Sarcoma Unit, Department of Surgical Oncology, Royal Marsden Hospital, London, UK. Electronic address: Shahnawaz.rasheed@rmh.nhs.uk. 15. Sarcoma Unit, Department of Surgical Oncology, Royal Marsden Hospital, London, UK. Electronic address: paris.tekkis@rmh.nhs.uk. 16. Gustave Roussy, Surgical Oncology department, France(2). Electronic address: charles.honore@gustaveroussy.fr. 17. Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, Amsterdam, the Netherlands. Electronic address: w.v.houdt@nki.nl. 18. Leiden University Medical Center, Department of Surgery, Leiden, the Netherlands. Electronic address: j.a.van_der_hage@lumc.nl. 19. Department of Surgery, Institut Curie, PSL University, Paris, France(2). Electronic address: sylvie.bonvalot@curie.fr. 20. Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, the Netherlands and European School of Soft Tissue Sarcoma Surgery, Amsterdam, the Netherlands. Electronic address: y.schrage@nki.nl. 21. Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, Amsterdam, the Netherlands. Electronic address: Myles.Smith@rmh.nhs.uk.
Abstract
BACKGROUND: Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach. METHODS: All rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses. RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048). CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.
BACKGROUND:Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach. METHODS: All rectal GISTpatients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses. RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048). CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.