Abstract
Background
The utility of adjuvant systemic therapy in small bowel gastrointestinal stromal tumor
remains unclear.
Methods
We queried the National Cancer Data Base for individuals having enterectomy to negative
margins for small bowel gastrointestinal stromal tumor between 2010 and 2015. Subjects
were categorized by tumor size (2.1–5 cm, 5.1–10 cm, >10 cm) and histologic grade
(≤5 mitoses/50 high-power field and >5 mitoses/50 high-power field). Cox proportional
hazard analysis was performed to evaluate the association between adjuvant therapy
and overall survival.
Results
One thousand five hundred fifty-nine patients met the inclusion criteria. On univariate
comparison to resection alone, adjuvant therapy was associated with improved overall
survival for individuals with high-grade tumors of intermediate and large size (85%
vs 48%, P = .010; 75% vs 47%, P = .003) but not for those with high-grade tumors of small size or low-grade tumors
of any size. On multivariable analysis adjusted for age, comorbid disease state, and
tumor size, adjuvant therapy was independently associated with reduced risk of mortality
for high-grade (hazard ratio 0.37, 95% confidence interval: 0.21–0.64) but not low-grade
tumors.
Conclusion
Adjuvant therapy after R0 resection for small bowel gastrointestinal stromal tumor
should be administered after careful consideration of the size and grade of a patient’s
tumor.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Gastrointestinal stromal tumors: pathology and prognosis at different sites.Semin Diagn Pathol. 2006; 23: 70-83
- One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial.JAMA. 2012; 307: 1265-1272
- Time to definitive failure to the first tyrosine kinase inhibitor in localized GI stromal tumors treated with imatinib as an adjuvant: a European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group intergroup randomized trial in collaboration with the Australasian Gastro-Intestinal Trials Group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas.J Clin Oncol. 2015; 33: 4276-4283
- Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial.Lancet. 2009; 373: 1097-1104
- Diagnosis of gastrointestinal stromal tumors: a consensus approach.Hum Pathol. 2002; 33: 459-465
- The National Cancer Data Base: a powerful initiative to improve cancer care in the United States.Ann Surg Oncol. 2008; 15: 683-690
- Prognostic factors of primary gastrointestinal stromal tumors: a cohort study based on high-volume centers.Chin J Cancer Res. 2018; 30: 61-71
- The impact of imatinib on survival and treatment trends for small bowel and colorectal gastrointestinal stromal tumors.J Gastrointest Surg. 2020; 24: 98-108
- Adjuvant therapy with imatinib in gastrointestinal stromal tumors (GISTs)-review and perspectives.Transl Gastroenterol Hepatol. 2019; 4: 24
Article info
Publication history
Published online: July 23, 2020
Accepted:
April 14,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
