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Comparable long-term survival of patients with colorectal or gastric gastrointestinal stromal tumors treated with endoscopic vs. surgical resection

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Abstract

Background and aims

With the development of endoscopic technology, endoscopic treatment has been widely used in Gastrointestinal stromal tumors (GISTs). However, population-based studies comparing the long-term results of patients who received endoscopic treatment vs. Surgery are lacking. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term survival of colorectal or gastric GISTs who underwent primary tumor resection (endoscopic therapy or surgery) in the USA.

Methods

Patients with colorectal or gastric GISTs were selected from the SEER database between 2010 and 2015. Kaplan–Meier analyses and log-rank tests were used to evaluate the difference in the long-term survival between the endoscopic therapy group and the surgery group. We examined the association between different treatments and survival after using the multivariate cox proportional hazards model to adjust the relevant covariates. Besides, we used Propensity score matching (PSM) to overcome the different distributions of covariates between the two groups and then further compare the survival difference.

Results

In total, 2355 patients were enrolled in our study, of which 1999 (84.9%) received surgical treatment and 356 (15.1%) received endoscopic treatment. There was no significant difference in overall survival (OS) between the two groups before PSM. The median OS (73.5 months vs. 72.2 months) and 5-year OS rate (85.7% vs. 81.5%) of endoscopic therapy were similar to surgical patients (P = 0.34). The median Cancer-specific survival (CSS) and 5-year CSS rate in the endoscopic treatment group were higher than the surgical group before PSM, with 81.3 months, 97.1% versus 78.8 months, 92.7% (P = 0.011). After adjusting for other clinical factors and PSM, the long-term OS and CSS did not significantly differ between those treated surgically and treated endoscopically.

Conclusion

Based on the American population, we preliminarily found that the long-term OS and CSS did not differ between patients undergoing endoscopic therapy and surgery.

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Data availability

All data used in this paper may be accessed via the SEER*Stat web program following the submission of a request for access to the data at https://seer.cancer.gov/seertrack/data/request/.

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Acknowledgements

We thank the Surveillance, Epidemiology, and End Results (SEER) database and our collaborators who helped with this study.

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Author notes

  1. Xiuhua Zhang and Guozhong Ji have contributed equally to this work.

Authors and Affiliations

  1. Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China

    Linlin Yin, Jingjing Wang, Rongjie Zhao, Kangdi Chen, Zuhong Ji, Guozhong Ji & Xiuhua Zhang

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Contributions

LLY designed the study. JJW and RJZ performed data mining. LLY, KDC, and ZHJ analyzed the data. LLY and JJW drafted the initial manuscript. GZJ and XHZ contributed to the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Guozhong Ji or Xiuhua Zhang.

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Disclosures

Linlin Yin, Jingjing Wang, Rongjie Zhao, Kangdi Chen, Zuhong Ji, Xiuhua Zhang, and Guozhong Ji have declared that they have no conflicts of interest or financial ties to disclose.

Ethical approval

Institutional review board approval was not needed for this study as it utilized publically available data.

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Supplementary Information

Below is the link to the electronic supplementary material.

464_2021_8755_MOESM1_ESM.tif

Supplementary file1 The appropriate cutoff values of age and tumor size was assessed by X-tile analysis (A, B). The appropriate cutoff values of age were 66 and 75 years (C, D). The appropriate cutoff values of tumor size were 56 and 143 mm (TIF 8626 kb)

464_2021_8755_MOESM2_ESM.tif

Supplementary file2 Forest plots summarize the HR and 95% CI of overall survival according to treatment methods (TIF 4561 kb)

464_2021_8755_MOESM3_ESM.tif

Supplementary file3 Forest plots summarize the HR and 95% CI of cancer-specific survival according to treatment methods (TIF 4586 kb)

Supplementary file4 (DOC 115 kb)

Supplementary file5 (DOC 67 kb)

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Yin, L., Wang, J., Zhao, R. et al. Comparable long-term survival of patients with colorectal or gastric gastrointestinal stromal tumors treated with endoscopic vs. surgical resection. Surg Endosc 36, 4215–4225 (2022). https://doi.org/10.1007/s00464-021-08755-w

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  • DOI: https://doi.org/10.1007/s00464-021-08755-w

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