Disappearance of racial disparities in gastrointestinal stromal tumor outcomes

The purpose of this study was to determine the effects of race, socioeconomic status, and demographic and clinical variables on the outcomes of gastrointestinal stromal tumors (GISTs).

The Surveillance, Epidemiology, and End Results (SEER) database was queried for GIST and other intestinal mesenchymal tumors from 1992 to 2005.

A total of 3,795 patients with mesenchymal tumors were identified. More than 88% of tumors were identified as GIST after the year 2000. Overall, patient demographics showed 53% men, 72.2% Caucasians, 15.6% African Americans, and 9.1% Hispanics. In patients diagnosed before the year 2000, 30-day surgical mortality was higher in African Americans (0.56% versus 0.76% Caucasians, p=0.012), although no difference was observed in tumor stage (p=0.446) or grade (p=0.495). African Americans underwent surgical extirpation less frequently (p=0.003). Multivariate analysis correcting for patient demographics, socioeconomic status, and clinical data demonstrated African-American race (hazards ratio 1.66, p < 0.001) and failure to undergo surgical extirpation (hazards ratio 2.930, p < 0.001) were independent predictors of poor prognosis. In patients diagnosed after 2000, 30-day surgical mortality was equivalent between races (0.46% versus 0.35%, p=0.517), and African Americans underwent surgical extirpation just as often as Caucasians did (p=0.153). Multivariate analysis for patients diagnosed after 2000 demonstrated no difference in survival by race (hazards ratio 1.27, p=0.126).

Before 2000, African Americans were less likely to have surgery, and they demonstrated an overall increased mortality rate for GIST. Since 2000, African Americans have benefited from increased surgical resection rates, decreased perioperative mortality, and improved longterm survival. These changes have appeared to erase racial disparities in the treatment of GIST.