Gastrointestinal stromal tumour in the elderly

Tham, Chee-Kian; Poon, Donald; Li, Huihua; Tan, Min-Han; Choo, Su-Pin; Foo, Kian Fong

doi:10.1016/j.critrevonc.2008.09.007

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…This is in accordance with earlier previous observation showing that lack of treatment could be the reason for their worse survival in elderly patients [31]. Meanwhile, Tham et al have proposed thatage alone might not deter the optimal management in patients with GISTs [28]. In fact, with the increasing life-expectancy of the elderly, it has been reported that patients over 75 years old have an average life expectancy of up to 12 years [9].…”

Section: Discussionsupporting

confidence: 90%

“…As previously shown, our ndings were supported by Kramer et al who elucidated that older age was an adverse and independent prognostic factor in GIST patients [32]. In contrast, a prior publication implied a similar survival outcome achieved between younger and older ones [28]. The reason for this divergence was due to the clinical endpoint RFS (recurrence free survival) and PFS (progression free survival) used by the latter.…”

Section: Discussionsupporting

confidence: 81%

“…Nevertheless, treatment decisions may be greatly in uenced by age, in part, as a result of the augmented incidence of comorbidities and progressive decline of function correlated with aging [11,27]. Although there are small numbers of analyses focusing on the treatment of older GISTs patients, these reports consisted of limited patients (18-139 cases) and incomplete treatment categories [28][29][30]. To our knowledge, this study represents the rst attempt to comprehensively depict patterns of treatment and a nomogram for individualized among a population-based analysis of elderly GISTs patients.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating Treatment Patterns of Gastrointestinal Stromal Tumors in the Elderly and Predicting Outcomes by a Validated Model: A Population-based Study

Zhao

Zhu

Zhang

2020

Preprint

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Abstract Background: Data on the management and outcome of gastrointestinal stromal tumors (GISTs) in elderlypatients are scant due to their poor representation in clinical trials. Methods:In total, 1379 elderly patients (≥65 years) histologically confirmed GIST between2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database.Results: As a result,surgery alone was the predominant treatment used in both age groups. Patients aged ≥75 years who underwent surgery alone had a median survival of 69 months, chemotherapy alone 51 months, surgery plus chemotherapy 60 months, and no therapy 51 months. While among patients aged 65-74 years, the median OS was not reached (NR), 49, 83, and NR, separately. Besides, C-indexes for the OS nomogram in the training set and validation set were0.771 and 0.761, respectively. Of importance, the predictive model displayed a comparable result to the 8th American Joint Committee on Cancer TNM staging system (p＜0.05), demonstrating improved model discrimination. Conclusions: For elderly patients with GISTs, surgery alone or surgery plus chemotherapy seemed feasible and effective, conferring potential survival benefits even in very elderly patients. Moreover, this simple-to-use nomogram may assist clinicians in treatment decision-making and effectively predict 3- and 5-year survival.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating Treatment Patterns of Gastrointestinal Stromal Tumors in the Elderly and Predicting Outcomes by a Validated Model: A Population-based Study

Zhao

Zhu

Zhang

2020

Preprint

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“…10,11 In terms of advanced age, it was reported to be associated with reduced survival for RCC, 26 but not for GIST in a smaller study. 27 Higher BMI has been described as a protective factor in prior studies in RCC, even after adjusting for stage, tumor size, and grade. 28 A potential explanation is differential expression of the fatty acid synthase gene, shown to be Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BMI, body mass index; BP, blood pressure; CI, confidence interval; GIST, gastrointestinal stromal tumor; OR, odds ratio.…”

Section: Discussionmentioning

confidence: 96%

Clinical risk factors for the development of hypertension in patients treated with inhibitors of the VEGF signaling pathway

Hamnvik

Choueiri

Turchin

et al. 2014

Cancer

184

138

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Background VEGF signaling pathway inhibitor (anti-VEGF) therapy is associated with hypertension, but little is known about predisposing clinical characteristics. This study describes the real-world association between baseline clinical characteristics, blood pressure (BP) response, and survival in patients prescribed anti-VEGF therapies. Methods Clinical data from Partners HealthCare in Massachusetts was obtained from adults treated with anti-VEGF therapies (2002–2013). Treatment-induced hypertensive response was defined as worsening of pre-existing hypertension or new diagnosis of hypertension (if no prior hypertension history). Results Data from 1120 patients with renal cell carcinoma (32.2%), hepatocellular carcinoma (11.6%), gastrointestinal stromal tumors (12.5%) and other sarcomas (15.3%) were analyzed. Most patients received sunitinib (52%), sorafenib (25.9%) or pazopanib (18%). A treatment-induced hypertensive response was identified in 49.7% of treated patients. Pre-existing hypertension, present in 65.4%, was an independent risk factor for BP elevation (odds ratio (OR) 1.56, 95% confidence interval (CI) 1.27–1.92); other risk factors included age ≥60 years (OR 1.26, 95%CI 1.06–1.52), and body mass index (BMI) ≥25 kg/m2 (OR 1.26, 95%CI 1.04–1.53). Race, gender, anti-VEGF therapy prescribed, and baseline antihypertensive class were not significant risk factors. The absolute observed mean increase in BP was 21 mmHg (systolic) / 15 mmHg (diastolic), both in patients with and without pre-existing hypertension. The development of hypertension predicted improved survival (hazard ratio 0.76, 95%CI 0.65–0.89). Conclusions Pre-existing hypertension, age, and BMI identify patients at risk for significant anti-VEGF therapy-induced BP elevation. Hypertension appears to be a clinical biomarker of efficacy to anti-VEGF therapies in a broad range of malignancies.

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“…However, some evidence indicates that age was not associated with survival for GIST patients. [9] Tham et al [17] demonstrated that patients older than 65 years showed a comparable outcome as younger patients. The role of age in GIST remains to be further investigated.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features and prognosis of coexistence of gastric gastrointestinal stromal tumor and gastric cancer

Liu

Liu²,

Zheng³

et al. 2016

Medicine

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The coexistence of gastric gastrointestinal stromal tumor (GIST) and gastric cancer is relatively high, and its prognosis is controversial due to the complex and variant kinds of presentation. Thus, the present study aimed to explore the clinicopathological features and prognostic factors of gastric GIST with synchronous gastric cancer.From May 2010 to November 2015, a total of 241 gastric GIST patients were retrospectively enrolled in the present study. The patients with coexistence of gastric GIST and gastric cancer were recorded. The clinicopathological features and prognoses of patients were analyzed.Among 241 patients, 24 patients had synchronous gastric cancer (synchronous group) and 217 patients did not (no-synchronous group). The synchronous group presented a higher percentage of elders (66.7% vs 39.6%, P = 0.001) and males (87.5% vs 48.4%, P < 0.001) than the no-synchronous group. The tumor diameter, mitotic index, and National Institutes of Health degree were also significantly different between the 2 groups (all P < 0.05). The 5-year disease-free survival and disease-specific survival rates of synchronous group were significantly lower than those of no-synchronous group (54.9% vs 93.5%, P < 0.001; 37.9% vs 89.9%, P < 0.001, respectively). However, the 5-year overall survival rates between synchronous and gastric cancer groups were comparable (37.9% vs 57.6%, P = 0.474).The coexistence of gastric GIST and gastric cancer was common in elder male patients. The synchronous GIST was common in low-risk category. The prognosis of gastric GIST with synchronous gastric cancer was worse than that of primary-single gastric GIST, but was comparable with primary-single gastric cancer.

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Gastrointestinal stromal tumour in the elderly

Cited by 18 publications

References 28 publications

Evaluating Treatment Patterns of Gastrointestinal Stromal Tumors in the Elderly and Predicting Outcomes by a Validated Model: A Population-based Study

Evaluating Treatment Patterns of Gastrointestinal Stromal Tumors in the Elderly and Predicting Outcomes by a Validated Model: A Population-based Study

Clinical risk factors for the development of hypertension in patients treated with inhibitors of the VEGF signaling pathway

Clinicopathological features and prognosis of coexistence of gastric gastrointestinal stromal tumor and gastric cancer

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