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Extra-intestinal location for primary non-metastatic GIST associated with increased risk for death

Issue: February 10, 2012

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2012 Gastrointestinal Cancers Symposium

SAN FRANCISCO — Compared with gastrointestinal stromal tumors located within the gastrointestinal tract, extra-intestinal location for primary non-metastatic gastrointestinal stromal tumor was an independent prognostic factor for reduced OS.

Patients with extra-intestinal gastrointestinal stromal tumors (EGIST) also had more locally advanced cancers with lymph node involvement (40.2% vs. 18.4%) and a higher occurrence of distant metastatic disease (22.3% vs. 16.6%).

“Extra-intestinal tumor location increased the risk for death by 28%,” said Mary Lydon Guye, MD, surgical oncology fellow at City of Hope in Duarte, Calif., who presented the results at the 2012 ASCO Gastrointestinal Cancers Symposium. “These analyses show that the extra-intestinal location confers a worse prognosis for GIST tumors even when matched for size and stage of disease.”

Guye and her colleagues used the SEER database to identify 2,951 patients with GIST treated with surgery from 1996 to 2008. Most patients (n=2,330) had a primary tumor location in the GI tract, while the remainder (n=261) had extra-intestinal tumors.

For the entire cohort, median survival was 113 months and 5-year OS was 68.7%. Median survival was 120 months for patients with GI tract tumors compared with 105 months for patients with extra-intestinal tumors, Guye said. Five-year OS also favored patients with primary tumors within the GI tract (62% vs. 70%; P=.002). Stepwise multivariate analysis showed that non-intestinal site was an independent predictor of poorer survival (HR=1.28; 95% CI, 1.02-1.62).

Patients with EGIST had larger tumors, so Guye and colleagues investigated whether the decrease in survival was due to confounding by tumor size. Researchers performed a matched analysis comparing survival for all patients with tumors larger than 10 cm.

“Even among all patients with the larger tumors, EGIST was still associated with decreased survival,” Guye said.

Patients with EGIST tumors presented at higher stage. Researchers found no difference in survival for patients with local disease, but patients with EGIST tumors had poorer survival with regional disease (70% vs. 59%) and distant metastatic disease (49% vs. 32%).

Location of the primary tumor was a significant independent prognostic factor for survival, along with tumor size and stage of disease. – by Jason Harris

For more information:

• Guye ML. Abstract #2. Presented at: ASCO Gastrointestinal Cancers Symposium; Jan. 19-21, 2012; San Francisco.

Disclosure: Dr. Guye reported no relevant financial disclosures.

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