Abstract
The postoperative recurrence risk of gastrointestinal stromal tumour (GIST) should be estimated when considering adjuvant systemic therapy. Previous studies in the literature have suggested that small intestinal GISTs are more aggressive than gastric GISTs. We assessed the prognostic role of the primary tumour site in patients with operable GIST to compare the outcomes of gastric and small intestinal GISTs over a decade of treatment. The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of gastric and small intestinal GISTs between 2004 and 2014 using the GIST-specific histology code (ICD-O-3 code 8936), and only patients with tissues sampled by surgical resection were selected for this study. Cancer-specific survival (CSS) and overall survival (OS) were compared between small intestinal and gastric GISTs using Cox regression analyses. GISTs were located in the stomach (n = 2594, 65%), duodenum (n = 228, 6%), and jejunum/ileum (n = 1176, 29%). The OS and CSS of patients with GISTs in the duodenum and jejunum/ileum were similar to those of patients with gastric GISTs in Cox regression analyses, except for the CSS of patients with tumour sizes 2.1-5 cm in diameter and ≤ 5 mitoses per 50 HPFs (HR 1.657; 95% CI 1.062-2.587, p = 0.026). Tumours sizes 2.1–5 cm in diameter and > 5 mitoses per 50 HPFs (HR 4.627; 95% CI 1.035-20.67, p = 0.045) in jejunal/ileal GIST locations had significantly worse CSS than did those in gastric GIST locations. In this large nationwide study, the primary tumour site was not an independent prognostic factor in patients with operable small intestinal and gastric GISTs.
Highlights
Gastrointestinal stromal tumours (GISTs) present as the most frequent mesenchymal tumours of the digestive tract
The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of gastric and small intestinal GISTs between 2004 and 2014 using the GIST-specific histology code (ICD-O-3 code 8936), and only patients with tissues sampled by surgical resection were selected for this study
In univariate Cox regression analyses, there were no significant differences in overall survival (OS) (hazard ratio (HR) 1.143; 95% confidence interval (CI) 0.983–328, p = 0.081) between jejunal/ileal and gastric GISTs, but there were significant differences in Cancer-specific survival (CSS) (HR 1.388; 95% CI 1.162–1.656, p = 0.000) between jejunal/ileal and gastric GISTs
Summary
Gastrointestinal stromal tumours (GISTs) present as the most frequent mesenchymal tumours of the digestive tract. The majority of GISTs are primarily located in stomach (60%) and small intestine (30%), followed by duodenum (5%) and colorectum (< 5%). A small proportion of GISTs (< 1%) occur in oesophagus or appendix. Rare occasions of extra-gastrointestinal GISTs are generally located in retroperitoneum, omentum or mesentery [2]. Radical resection accompanied by postoperative radiologic follow-up for relapse is the standard regimen for primary, resectable, localised GISTs. due to the recurrence occurred in a number of patients after radical surgery, administration of imatinib in postoperative stage has been studying to examine its role in decreasing relapse [3]. A tyrosine kinase inhibitor (TKI), gained approval from the Food and Drug Administration (FDA) for GISTs therapy in 2002 after clinical trials demonstrating that its postoperative use in intermediatewww.impactjournals.com/oncotarget to high-risk subjects prolonged overall survival (OS) and recurrence-free survival (RFS) [4]
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