Population-Based Epidemiology and Mortality of Small Malignant Gastrointestinal Stromal Tumors in the USA

Coe, Taylor M.; Fero, Katherine E.; Fanta, Paul T.; Mallory, Robert J.; Tang, Chih‐Min; Murphy, James D.; Sicklick, Jason K.

doi:10.1007/s11605-016-3134-y

Cited by 66 publications

(51 citation statements)

References 25 publications

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“…Moreover, A study from Germany showed among the consecutive 98 autopsy cases, miro-GIST (less than 1 cm) were found in 22 patients (22.5%) [7]. A latest population-Based study [8] for milli-GIST (<2 cm) in the National Cancer Institute’s SEER database showed that the annual incidence rate of gastric milli-GISTs was 2.6 per 10 million.…”

Section: Discussionmentioning

confidence: 99%

The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

et al. 2017

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BackgroudThe detectable rate of minimal gastric GISTs has continuously increased. While the surveillance and management of GIST <2 cm have been deemed controversial or lack evidence-based approaches. The aim of the current study is to propose a cut-off value of tumor size for treatment policy and the appropriate timing for endoscopic ultrasonography (EUS) follow-up in the minimal EUS-suspected gastric GIST patients.MethodsA single-institution retrospective study was performed. 69 patients with EUS-suspected gastric GISTs were studied from November 2008 to March 2015. 69 patients with minimal gastric GISTs ≤2 cm diagnosed by EUS were followed for a mean period of 29 months (range, 12 to 70). An at least 20% increase of the maximal diameter of the tumors was set as a significant change.ResultsDuring follow-up, Of the 69 minimal EUS-suspected GISTs, 16 (23.2%) showed significant changes in size. 11 out of 69 GISTs (15.9%), 6 out of 43 GISTs (14.0%), 7 out of 30 GISTs (23.3%) showed significant changes in size, at 1 year, 2 years, and more than 3 years respectively. The receiver operating characteristic curve analysis showed that the tumor size cut-off was 9.5 mm. Only 4.7 and 3.7% of gastric EUS-suspected GISTs of <9.5 mm in size showed significant changes at 1 year and 2 years, while 9.5% at more than 3 years. 34.6, 31.3 and 55.6% of gastric EUS-suspected GISTs of ≥ 9.5 mm in size showed significant changes at 1 year, 2 years and more than 3 years.ConclusionsMinimal EUS-suspected GISTs, larger than 9.5 mm may be associated with significant progression. The patients with a ≥ 9.5 mm GIST should have a EUS 6–12months, while <9.5 mm GIST may have a EUS extended to every 2–3 years.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0567-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

et al. 2017

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“…Notably, small bowel GIST tumors show highest incidence among Asian/Pacific Islanders [51]. However, when considering GIST tumors in any part of the gastrointestinal tract, Blacks have highest incidence of all populations [52,53]. …”

Section: Introductionmentioning

confidence: 99%

Racial Disparity in Gastrointestinal Cancer Risk

et al. 2017

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Cancer from the gastrointestinal tract and its associated excretory organs will occur in over 300,000 Americans in 2017, with colorectal cancer responsible for over forty percent of that burden; there will be over 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to these cancers’ incidence and mortality exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in Non-Hispanic Whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among Blacks. Liver cancer has been most frequent among Asian/Pacific Islanders chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene-environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas and colorectum show the highest rates among Blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socio-economic and health care access, treatment and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biological and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.

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“…Coe et al published the first population-based analysis of malignant GIST <2 cm throughout the gastrointestinal (GI) tract and identified a mortality risk that has been underappreciated by gastroenterologists, surgeons, and oncologists. 61 In fact, they found that the 5-year GIST-specific mortality rate was 12.9%. Furthermore, 11% of patients with GIST <2 cm had regional or distant metastases.…”

Section: Small Gistmentioning

confidence: 98%

Evidence for improvements to risk stratification in high-risk gastrointestinal stromal tumor patients

Greco¹,

Rossi²,

Ruffolo³

et al. 2018

GICTT

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Significant prognostic heterogeneity has been described with GISTs, which can range from clinically benign to frankly malignant tumors. Although several GISTs classification systems have been established to identify tumors with high risk of relapse, there is a sample of patients who still do not receive an appropriate treatment. The classification scores by Fletcher et al and Miettinen and Lasota are the most widely clinically accepted, while the Memorial Sloan Kettering Cancer Center prognostic nomogram is considered the most feasible. There are several studies about new prognostic factors in radiological, biological, and surgical fields. Tumors with mixed growth pattern, enlarged vessels feeding, or draining the mass on computed tomography or with high standardized uptake values on positron emission tomography/ computed tomography should be considered as high-grade GISTs. Among biological markers, the most relevant are programmed cell death ligand 1, Pfetin, SETD2, SLITRK3, mir-215-5p, and monoglyceride lipase. These factors need to be further investigated in order to validate their use in risk stratification. Laparoscopy and open surgery can have the same oncological outcomes even for larger gastric tumors, up to 10 cm. Laparoscopy should be considered the best surgical approach when executed by skilled surgeons and for tumor localized in reachable sites. Adjuvant chemotherapy with imatinib is recommended for high-grade GIST, but the optimal duration of this therapy is still debated. Some authors advocated that imatinib treatment should last for 5 years. A subgroup of GIST is represented by small GISTs, lesions <2 cm in diameter, which need a radical surgical treatment in the presence of symptoms or when high-risk factors such as irregular borders, cystic spaces, ulceration, echogenic foci, internal heterogeneity, tumor progression during follow-up, small intestinal or colorectal localization are present.

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Population-Based Epidemiology and Mortality of Small Malignant Gastrointestinal Stromal Tumors in the USA

Cited by 66 publications

References 25 publications

The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors

Racial Disparity in Gastrointestinal Cancer Risk

Evidence for improvements to risk stratification in high-risk gastrointestinal stromal tumor patients

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