Abstract
BackgroundThe objective of the present population-based analysis was to assess survival patterns in patients with resected and metastatic GIST.MethodsPatients with histologically proven GIST were extracted from the Surveillance, Epidemiology and End Results (SEER) database from 1998 through 2011. Survival was determined applying Kaplan-Meier-estimates and multivariable Cox-regression analyses. The impact of size and mitotic count on survival was assessed with a generalized receiver-operating characteristic-analysis.ResultsOverall, 5138 patients were included. Median age was 62 years (range: 18–101 years), 47.3 % were female, 68.8 % Caucasians. GIST location was in the stomach in 58.7 % and small bowel in 31.2 %. Lymph node and distant metastases were found in 5.1 and 18.0 %, respectively. For non-metastatic GIST, three-year overall survival increased from 68.5 % (95 % CI: 58.8–79.8 %) in 1998 to 88.6 % (95 % CI: 85.3–92.0 %) in 2008, cancer-specific survival from 75.3 % (95 % CI: 66.1–85.9 %) in 1998 to 92.2 % (95 % CI: 89.4–95.1 %) in 2008. For metastatic GIST, three-year overall survival increased from 15.0 % (95 % CI: 5.3–42.6 %) in 1998 to 54.7 % (95 % CI: 44.4–67.3 %) in 2008, cancer-specific survival from 15.0 % (95 % CI: 5.3–42.6 %) in 1998 to 61.9 % (95 % CI: 51.4–74.5 %) in 2008 (all PTrend < 0.05).ConclusionsThis is the first SEER trend analysis assessing outcomes in a large cohort of GIST patients over a 11-year time period. The analysis provides compelling evidence of a statistically significant and clinically relevant increase in overall and cancer-specific survival from 1998 to 2008, both for resected as well as metastatic GIST.
Highlights
The objective of the present population-based analysis was to assess survival patterns in patients with resected and metastatic Gastrointestinal stromal tumors (GIST)
Around the change of millennium physicians began to understand that GIST are a result of a KIT or PDGFR mutation and more importantly, that the resulting mutated KIT or PDGF receptor could be blocked by the tyrosine kinase inhibitor imatinib
The primary objective of the present analysis was to assess whether overall and cancer-specific survival of GIST patients have improved over a 11-year time period
Summary
SEER data were collected and reported using data items and codes as documented by the North American Association of Central Cancer Registries (NAACCR) [8]. GIST patients were identified by the primary sites esophagus, stomach, small intestine, colon, rectum, appendix, peritoneum and the codes “8935” and “8936” for ICD-O-3 histology. Patients with other SEER reportable cancers were excluded unless the GIST was the first diagnosed malignancy (NAACCR Item 380) in order to use the cancer-specific survival. Patients with pediatric GIST (n = 24) were excluded from the analysis (Fig. 1). For analysis of overall survival, the time from diagnosis until the end of the follow-up was used. Extrapolation of survival rates was based on the covariate vector for the year of diagnosis modeled as a factorial variable in Cox regression.
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