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Younger GIST patients have better survival with small intestine vs. stomach tumors
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Gastrointestinal stromal tumors in the small intestine were associated with better survival compared with stomach tumors in adolescents and young adults aged younger than 40 years, according to the results of a retrospective cohort study.
For older adults, in which GISTs occur more commonly, the opposite is the case, according to Katherine Fero, MAS, of the School of Medicine at University of California, San Diego, La Jolla. “Many earlier studies, including one from our group, have shown that stomach GISTs have a better prognosis when we look at all patients with GIST,” she said in a press release. “Thus, there is likely something biologically unique about GISTs in younger people.”
Aiming to characterize a large cohort of adolescents and young adults with GISTs, and to determine whether surgical treatment is associated with improved survival, Fero and colleagues used the SEER database to identify 392 patients aged 13 to 39 years (52.8% male; 70.7% white) and 5,373 patients aged older than 40 years (51.5% men; 68.1% white) who were diagnosed with GIST from 2001 through 2013 and followed up through 2015.
They found that younger patients had small-intestine GISTs more often than older patients (35.5% vs. 27.3%; P = .008) and were also more likely to receive surgical treatment (84.7% vs. 78.4%; P = .003).
Multivariable analysis revealed that younger patients who underwent surgery had more than a twofold lower GIST-related mortality risk compared with younger patients who were managed without surgery (subdistribution HR = 2.27; 95% CI, 1.21-2.25).
Further analysis of a subset of 349 younger patients showed tumors located in the small intestine were associated with improved OS (91.1% vs. 77.2%; P = .01) and improved GIST-specific survival (91.8% vs. 78%; P = .008) compared with tumors located in the stomach.
Additionally, analysis of a subset of 91 younger patients with metastatic disease showed surgical management was associated with improved OS (69.5% vs. 53.7%; P = .04) and improved GIST-specific survival (71.5% vs. 56.7%; P = .03).
“The study suggests that in [adolescent and young adult] patients, surgical management of their GIST is associated with improved overall and GIST-specific survival, including among patients whose cancer has spread,” Jason Sicklick, MD, associate professor of surgery and surgical oncologist at Moores Cancer Center at UC San Diego Health, said in the press release.
The association between small intestine tumor location and improved survival in younger patients, along with the “lack of effect from tumor size on outcome ... are contrary to contemporary population pooled analysis that found nongastric site and large tumor size as significant risk factors for poor outcome,” Donal B. O’Connor, MD, and Kevin C. Conlon, MD, of the department of surgery at the University of Dublin, Trinity College in Ireland, wrote in a related editorial. “This finding raises the possibility that GISTs in [adolescent and young adult] patients could have a distinct tumor biology.”
They also noted that the absence of data on use of tyrosine kinase inhibition (TKI) is a significant limitation of the study.
“The use of TKIs during the last decade in the management of GISTs has had a definite effect on disease-free survival and OS,” they wrote. “Whether [adolescent and young adult] patients would benefit from such a strategy cannot be determined from the current study.” – by Adam Leitenberger
Disclosures: The researchers and editorial authors report no relevant financial disclosures.
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