Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors
Background Society guidelines remain inconsistent on the role of endoscopic and radiographic surveillance as an alternative to surgical resection of small gastric gastrointestinal stromal tumors (GISTs). Herein, we aimed to assess survival among patients with gastric GISTs undergoing observation ver...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2023-10, Vol.27 (10), p.2076-2084 |
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| creator | Rhodin, Kristen E DeLaura, Isabel F Horne, Elizabeth Bartholomew, Alex Howell, Thomas C Kanu, Elishama Masoud, Sabran Lidsky, Michael E Nussbaum, Daniel P Blazer, Dan G |
| description | Background
Society guidelines remain inconsistent on the role of endoscopic and radiographic surveillance as an alternative to surgical resection of small gastric gastrointestinal stromal tumors (GISTs). Herein, we aimed to assess survival among patients with gastric GISTs undergoing observation versus surgical resection, stratified by tumor size.
Methods
The National Cancer Database (NCDB) was queried for gastric GISTs
<
2 cm diagnosed from 2010-2017. Patients were stratified by management strategy—observation vs surgical resection. The primary outcome, overall survival (OS), was examined with Kaplan-Meier and multivariable Cox proportional hazard methods. Subgroup analyses were conducted on tumors < 1 cm and 1–2 cm in size.
Results
Altogether, 1208 patients were identified: 439 (36.3%) undergoing observation and 769 (63.7%) receiving surgical resection. In the overall cohort, patients undergoing surgical resection demonstrated improved survival (93.6 vs. 88.8% 5-year OS,
p
=0.02). In multivariable analysis, upfront surgical resection was not associated with a reduction in mortality; however, there was a significant interaction with tumor size. For patients with tumors < 1 cm, there was no difference in survival based on management strategy. However, resection of tumors 1–2 cm was associated with improved survival relative to surveillance.
Conclusions
While surgical resection and surveillance were associated with similar survival for patients with gastric GISTs < 1 cm, this NCDB analysis suggests that patients with tumor size ≥ 1 cm may benefit from upfront surgical resection. Prospective studies comparing these two approaches and their impact on recurrence-free and disease-specific survival are needed to better align consensus guidelines and recommendations. |
| doi_str_mv | 10.1007/s11605-023-05779-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10592390</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2877586935</sourcerecordid><originalsourceid>FETCH-LOGICAL-c382t-f9ae8d70dbd66a92c8e3e2f8255a4dc9ef55d67a6a47b7b308d8c8fcbfad52b93</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhS1ERUvhD7BAkdiwCfUjfq0Qqkqp1KqLWyR2ZmI7F1eJfbGTK8GvxyWlPBasZqzzzfGMDkIvCH5DMJYnhRCBeYspazGXUrfiEToiSrK2E1Q8rj3WpKWcfzpET0u5xZhITNQTdMhkx5jm-Ah9vph2YOcmDc3NMqXcbMJ330B0zRVE2PrJxyrGZrPkfdjD2ITaTzCOzTmUOQe71hTi7MscYiU29VmJ1a88QwcDjMU_v6_H6OP7s5vTD-3l9fnF6bvL1jJF53bQ4JWT2PVOCNDUKs88HVTdHjpntR84d0KCgE72smdYOWXVYPsBHKe9Zsfo7eq7W_rJO1v3zjCaXQ4T5G8mQTB_KzF8Mdu0NwRzTZnG1eH1vUNOX5d6jZlCsX4cIfq0FEMVE7Sioqvoq3_Q27TkevwdJSVXQjNeKbpSNqdSsh8etiHY3CVo1gRNTdD8TNCIOvTyzzseRn5FVgG2AqVKcevz77__Y_sDftupGg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2877586935</pqid></control><display><type>article</type><title>Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>Alma/SFX Local Collection</source><creator>Rhodin, Kristen E ; DeLaura, Isabel F ; Horne, Elizabeth ; Bartholomew, Alex ; Howell, Thomas C ; Kanu, Elishama ; Masoud, Sabran ; Lidsky, Michael E ; Nussbaum, Daniel P ; Blazer, Dan G</creator><creatorcontrib>Rhodin, Kristen E ; DeLaura, Isabel F ; Horne, Elizabeth ; Bartholomew, Alex ; Howell, Thomas C ; Kanu, Elishama ; Masoud, Sabran ; Lidsky, Michael E ; Nussbaum, Daniel P ; Blazer, Dan G</creatorcontrib><description>Background
Society guidelines remain inconsistent on the role of endoscopic and radiographic surveillance as an alternative to surgical resection of small gastric gastrointestinal stromal tumors (GISTs). Herein, we aimed to assess survival among patients with gastric GISTs undergoing observation versus surgical resection, stratified by tumor size.
Methods
The National Cancer Database (NCDB) was queried for gastric GISTs
<
2 cm diagnosed from 2010-2017. Patients were stratified by management strategy—observation vs surgical resection. The primary outcome, overall survival (OS), was examined with Kaplan-Meier and multivariable Cox proportional hazard methods. Subgroup analyses were conducted on tumors < 1 cm and 1–2 cm in size.
Results
Altogether, 1208 patients were identified: 439 (36.3%) undergoing observation and 769 (63.7%) receiving surgical resection. In the overall cohort, patients undergoing surgical resection demonstrated improved survival (93.6 vs. 88.8% 5-year OS,
p
=0.02). In multivariable analysis, upfront surgical resection was not associated with a reduction in mortality; however, there was a significant interaction with tumor size. For patients with tumors < 1 cm, there was no difference in survival based on management strategy. However, resection of tumors 1–2 cm was associated with improved survival relative to surveillance.
Conclusions
While surgical resection and surveillance were associated with similar survival for patients with gastric GISTs < 1 cm, this NCDB analysis suggests that patients with tumor size ≥ 1 cm may benefit from upfront surgical resection. Prospective studies comparing these two approaches and their impact on recurrence-free and disease-specific survival are needed to better align consensus guidelines and recommendations.</description><identifier>ISSN: 1091-255X</identifier><identifier>ISSN: 1873-4626</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-023-05779-6</identifier><identifier>PMID: 37433950</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biopsy ; Cancer ; Comorbidity ; Demographics ; Endoscopy ; Gastroenterology ; Gastrointestinal cancer ; Gastrointestinal Stromal Tumors - diagnostic imaging ; Gastrointestinal Stromal Tumors - surgery ; Gastrointestinal surgery ; Humans ; Laparoscopy - methods ; Medical prognosis ; Medicine ; Medicine & Public Health ; Mortality ; Oncology ; Original Article ; Patients ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Surgery ; Surveillance ; Survival analysis ; Treatment Outcome ; Tumors ; Variance analysis</subject><ispartof>Journal of gastrointestinal surgery, 2023-10, Vol.27 (10), p.2076-2084</ispartof><rights>The Society for Surgery of the Alimentary Tract 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Society for Surgery of the Alimentary Tract.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c382t-f9ae8d70dbd66a92c8e3e2f8255a4dc9ef55d67a6a47b7b308d8c8fcbfad52b93</cites><orcidid>0000-0002-3249-5330</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-023-05779-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-023-05779-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37433950$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rhodin, Kristen E</creatorcontrib><creatorcontrib>DeLaura, Isabel F</creatorcontrib><creatorcontrib>Horne, Elizabeth</creatorcontrib><creatorcontrib>Bartholomew, Alex</creatorcontrib><creatorcontrib>Howell, Thomas C</creatorcontrib><creatorcontrib>Kanu, Elishama</creatorcontrib><creatorcontrib>Masoud, Sabran</creatorcontrib><creatorcontrib>Lidsky, Michael E</creatorcontrib><creatorcontrib>Nussbaum, Daniel P</creatorcontrib><creatorcontrib>Blazer, Dan G</creatorcontrib><title>Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
Society guidelines remain inconsistent on the role of endoscopic and radiographic surveillance as an alternative to surgical resection of small gastric gastrointestinal stromal tumors (GISTs). Herein, we aimed to assess survival among patients with gastric GISTs undergoing observation versus surgical resection, stratified by tumor size.
Methods
The National Cancer Database (NCDB) was queried for gastric GISTs
<
2 cm diagnosed from 2010-2017. Patients were stratified by management strategy—observation vs surgical resection. The primary outcome, overall survival (OS), was examined with Kaplan-Meier and multivariable Cox proportional hazard methods. Subgroup analyses were conducted on tumors < 1 cm and 1–2 cm in size.
Results
Altogether, 1208 patients were identified: 439 (36.3%) undergoing observation and 769 (63.7%) receiving surgical resection. In the overall cohort, patients undergoing surgical resection demonstrated improved survival (93.6 vs. 88.8% 5-year OS,
p
=0.02). In multivariable analysis, upfront surgical resection was not associated with a reduction in mortality; however, there was a significant interaction with tumor size. For patients with tumors < 1 cm, there was no difference in survival based on management strategy. However, resection of tumors 1–2 cm was associated with improved survival relative to surveillance.
Conclusions
While surgical resection and surveillance were associated with similar survival for patients with gastric GISTs < 1 cm, this NCDB analysis suggests that patients with tumor size ≥ 1 cm may benefit from upfront surgical resection. Prospective studies comparing these two approaches and their impact on recurrence-free and disease-specific survival are needed to better align consensus guidelines and recommendations.</description><subject>Biopsy</subject><subject>Cancer</subject><subject>Comorbidity</subject><subject>Demographics</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gastrointestinal cancer</subject><subject>Gastrointestinal Stromal Tumors - diagnostic imaging</subject><subject>Gastrointestinal Stromal Tumors - surgery</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Survival analysis</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Variance analysis</subject><issn>1091-255X</issn><issn>1873-4626</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUtv1TAQhS1ERUvhD7BAkdiwCfUjfq0Qqkqp1KqLWyR2ZmI7F1eJfbGTK8GvxyWlPBasZqzzzfGMDkIvCH5DMJYnhRCBeYspazGXUrfiEToiSrK2E1Q8rj3WpKWcfzpET0u5xZhITNQTdMhkx5jm-Ah9vph2YOcmDc3NMqXcbMJ330B0zRVE2PrJxyrGZrPkfdjD2ITaTzCOzTmUOQe71hTi7MscYiU29VmJ1a88QwcDjMU_v6_H6OP7s5vTD-3l9fnF6bvL1jJF53bQ4JWT2PVOCNDUKs88HVTdHjpntR84d0KCgE72smdYOWXVYPsBHKe9Zsfo7eq7W_rJO1v3zjCaXQ4T5G8mQTB_KzF8Mdu0NwRzTZnG1eH1vUNOX5d6jZlCsX4cIfq0FEMVE7Sioqvoq3_Q27TkevwdJSVXQjNeKbpSNqdSsh8etiHY3CVo1gRNTdD8TNCIOvTyzzseRn5FVgG2AqVKcevz77__Y_sDftupGg</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Rhodin, Kristen E</creator><creator>DeLaura, Isabel F</creator><creator>Horne, Elizabeth</creator><creator>Bartholomew, Alex</creator><creator>Howell, Thomas C</creator><creator>Kanu, Elishama</creator><creator>Masoud, Sabran</creator><creator>Lidsky, Michael E</creator><creator>Nussbaum, Daniel P</creator><creator>Blazer, Dan G</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3249-5330</orcidid></search><sort><creationdate>20231001</creationdate><title>Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors</title><author>Rhodin, Kristen E ; 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Society guidelines remain inconsistent on the role of endoscopic and radiographic surveillance as an alternative to surgical resection of small gastric gastrointestinal stromal tumors (GISTs). Herein, we aimed to assess survival among patients with gastric GISTs undergoing observation versus surgical resection, stratified by tumor size.
Methods
The National Cancer Database (NCDB) was queried for gastric GISTs
<
2 cm diagnosed from 2010-2017. Patients were stratified by management strategy—observation vs surgical resection. The primary outcome, overall survival (OS), was examined with Kaplan-Meier and multivariable Cox proportional hazard methods. Subgroup analyses were conducted on tumors < 1 cm and 1–2 cm in size.
Results
Altogether, 1208 patients were identified: 439 (36.3%) undergoing observation and 769 (63.7%) receiving surgical resection. In the overall cohort, patients undergoing surgical resection demonstrated improved survival (93.6 vs. 88.8% 5-year OS,
p
=0.02). In multivariable analysis, upfront surgical resection was not associated with a reduction in mortality; however, there was a significant interaction with tumor size. For patients with tumors < 1 cm, there was no difference in survival based on management strategy. However, resection of tumors 1–2 cm was associated with improved survival relative to surveillance.
Conclusions
While surgical resection and surveillance were associated with similar survival for patients with gastric GISTs < 1 cm, this NCDB analysis suggests that patients with tumor size ≥ 1 cm may benefit from upfront surgical resection. Prospective studies comparing these two approaches and their impact on recurrence-free and disease-specific survival are needed to better align consensus guidelines and recommendations.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37433950</pmid><doi>10.1007/s11605-023-05779-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3249-5330</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals; Alma/SFX Local Collection |
| subjects | Biopsy Cancer Comorbidity Demographics Endoscopy Gastroenterology Gastrointestinal cancer Gastrointestinal Stromal Tumors - diagnostic imaging Gastrointestinal Stromal Tumors - surgery Gastrointestinal surgery Humans Laparoscopy - methods Medical prognosis Medicine Medicine & Public Health Mortality Oncology Original Article Patients Prospective Studies Retrospective Studies Stomach Neoplasms - pathology Stomach Neoplasms - surgery Surgery Surveillance Survival analysis Treatment Outcome Tumors Variance analysis |
| title | Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors |
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