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The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors

  • 2019 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008.

Methods

Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004–2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models.

Results

A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009–2015: adjusted HR [AHR] 0.73, 95% CI 0.59–0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19–1.53; 10-year AHR 1.23, 95% CI 1.09–1.38; each p < 0.001).

Conclusion

CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.

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Acknowledgments

Mr. Edwin Lewis provided generous support of Dr. Efron’s Department of Surgery Research Fund.

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Authors and Affiliations

  1. Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA

    Hamda Almaazmi, Miloslawa Stem, Brian D. Lo, James P. Taylor, Sandy H. Fang, Bashar Safar, Jonathan E. Efron & Chady Atallah

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  1. Hamda Almaazmi
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  2. Miloslawa Stem
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Contributions

Dr. Almaazmi: concept and design of the work, data acquisition, interpretation of data, drafting and revising the work, final approval. Mrs. Stem: design of the work, data acquisition and analysis, interpretation of data, drafting and revising the work, final approval. Mr. Lo and Dr. Taylor: design of the work, interpretation of data, drafting and revising the work, final approval. Dr. Fang and Dr. Safar: interpretation of data, revising the work, final approval. Dr. Efron: design of the work, data acquisition, interpretation of data, revising the work, final approval. Dr. Atallah: concept and design of the work, interpretation of data, revising the work, final approval. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Chady Atallah.

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Disclaimers

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the sources of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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The authors declare that they have no conflict of interest.

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This abstract was presented as a Quick Shot Presentation at Digestive Disease Weekly, May 18–21, 2019, San Diego, CA, USA.

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Almaazmi, H., Stem, M., Lo, B.D. et al. The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors. J Gastrointest Surg 24, 98–108 (2020). https://doi.org/10.1007/s11605-019-04344-4

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