Nationwide trends in the incidence and outcome of patients with gastrointestinal stromal tumour in the imatinib era

Abstract

BackgroundThe incidence, treatment and outcome of patients with newly diagnosed gastrointestinal stromal tumour (GIST) were studied in an era known for advances in diagnosis and treatment.MethodsNationwide population‐based data were retrieved from the Netherlands Cancer Registry. All patients with GIST diagnosed between 2001 and 2012 were included. Primary treatment, defined as any treatment within the first 6–9 months after diagnosis, was studied. Age‐standardized incidence was calculated according to the European standard population. Changes in incidence were evaluated by calculating the estimated annual percentage change (EAPC). Relative survival was used for survival calculations with follow‐up available to January 2017.ResultsA total of 1749 patients (54·0 per cent male and median age 66 years) were diagnosed with a GIST. The incidence of non‐metastatic GIST increased from 3·1 per million person‐years in 2001 to 7·0 per million person‐years in 2012; the EAPC was 7·1 (95 per cent c.i. 4·1 to 10·2) per cent (P < 0·001). The incidence of primary metastatic GIST was 1·3 per million person‐years, in both 2001 and 2012. The 5‐year relative survival rate increased from 71·0 per cent in 2001–2004 to 81·4 per cent in 2009–2012. Women had a better outcome than men. Overall, patients with primary metastatic GIST had a 5‐year relative survival rate of 48·2 (95 per cent c.i. 42·0 to 54·2) per cent compared with 88·8 (86·0 to 91·4) per cent in those with non‐metastatic GIST.ConclusionThis population‐based nationwide study found an incidence of GIST in the Netherlands of approximately 8 per million person‐years. One in five patients presented with metastatic disease, but relative survival improved significantly over time for all patients with GIST in the imatinib era.

Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

“…For patients with metastatic GISTs, it remains controversial however, if primary tumor removal could confer a survival benefit in the setting of distant metastases ( 20 ). With the advances in the cognition of molecular mechanisms, IM has been proposed as principle therapy in the management of metastatic GISTs with a reported overall survival of up to 81 months, representing a paradigm shift in targeted therapy ( 9 , 21 ). Hence, for the purpose of more intuitively appraising the effectiveness of surgery in the metastatic setting, we conducted the study under the premise that all patients had received chemotherapy.…”

“…For patients with metastatic GISTs, it remains controversial however, if primary tumor removal could confer a survival benefit in the setting of distant metastases (20). With the FIGURE 5 | Forest plots summarize the HR and 95% CI of (A) overall and (B) cancer-specific survival according to whether patients underwent primary tumor surgery in subgroup analyses.…”

Population-based incidence of gastrointestinal stromal tumors in Puglia

“…While taking into account the statistical imprecision, the estimate of the increasing trend of incidence (APC 2.4%) recorded in this study is in agreement with that found in other studies. 20–22 This increase is generally attributed to the improved capacity of detection and identification of GISTs through imaging, endoscopy, and endoscopic ultrasound and the increased awareness and interest in this nosologic entity by physicians and pathologists, rather than to a real increase in incidence. 20,22,23…”

Survival in advanced GIST has improved over time and correlates with increased access to post-imatinib tyrosine kinase inhibitors: results from Life Raft Group Registry

“…The reported survival times for GIST patients vary widely depending on stage of disease [15], the era reported [16–18] and the landmark used for measuring survival. The extent of improved survival due to individual lines of TKI therapy is unclear.…”