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Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

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.

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Acknowledgements

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’s NCDB are the source 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.

Funding

K. Rhodin is supported by the NIH 1R38AI140297 and the Duke Cancer Institute as part of the P30 Cancer Center Support Grant (Grant ID: P30 CA014236).

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Authors and Affiliations

  1. Department of Surgery, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA

    Kristen E Rhodin, Isabel F DeLaura, Elizabeth Horne, Alex Bartholomew, Thomas C Howell, Elishama Kanu, Sabran Masoud, Michael E Lidsky, Daniel P Nussbaum & Dan G Blazer 3rd

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  1. Kristen E Rhodin
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  2. Isabel F DeLaura
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Contributions

Study conception and design: KR, DB, ML, and DN; data acquisition and analysis: KR; data interpretation: all authors; drafting and revision of manuscript: all authors.

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Correspondence to Kristen E Rhodin.

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Conference Presentation: Oral Poster Presentation at the Annual Society of Surgical Oncology Meeting, March 23, 2023, Boston, MA, USA.

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Rhodin, K.E., DeLaura, I.F., Horne, E. et al. Impact of Tumor Size and Management on Survival in Small Gastric Gastrointestinal Stromal Tumors. J Gastrointest Surg 27, 2076–2084 (2023). https://doi.org/10.1007/s11605-023-05779-6

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