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Adjuvant systemic therapy for small bowel gastrointestinal stromal tumor (GIST): Is there a survival benefit after R0
Dhruv J Patel1, Waseem Lutfi2, Emanuel Eguia3
1Loyola University Chicago Stritch School of Medicine, IL.
Background:
The utility of adjuvant systemic therapy in small bowel gastrointestinal stromal tumor remains unclear.
Methods:
We queried the National Cancer Data Base for individuals having enterectomy to negative margins for small bowel gastrointestinal stromal tumor between 2010 and 2015. Subjects were categorized by tumor size (2.1-5 cm, 5.1-10 cm, >10 cm) and histologic grade (≤5 mitoses/50 high-power field and >5 mitoses/50 high-power field). Cox proportional hazard analysis was performed to evaluate the association between adjuvant therapy and overall survival.
Results:
One thousand five hundred fifty-nine patients met the inclusion criteria. On univariate comparison to resection alone, adjuvant therapy was associated with improved overall survival for individuals with high-grade tumors of intermediate and large size (85% vs 48%, P = .010; 75% vs 47%, P = .003) but not for those with high-grade tumors of small size or low-grade tumors of any size. On multivariable analysis adjusted for age, comorbid disease state, and tumor size, adjuvant therapy was independently associated with reduced risk of mortality for high-grade (hazard ratio 0.37, 95% confidence interval: 0.21-0.64) but not low-grade tumors.
Conclusion:
Adjuvant therapy after R0 resection for small bowel gastrointestinal stromal tumor should be administered after careful consideration of the size and grade of a patient's tumor.
Insights
Adjuvant therapy improves survival for high-grade, larger small bowel gastrointestinal stromal tumors. Low-grade tumors do not benefit from this treatment, regardless of size.
Area of Science:
- Surgical Oncology
- Gastrointestinal Oncology
- Cancer Research
Background:
- The role of adjuvant systemic therapy in small bowel gastrointestinal stromal tumors (SB-GIST) is not well-defined.
- Optimal treatment strategies for SB-GIST require further investigation.
Purpose of the Study:
- To evaluate the association between adjuvant therapy and overall survival in patients with resected small bowel gastrointestinal stromal tumors.
- To identify patient subgroups who may benefit from adjuvant systemic therapy.
Main Methods:
- Retrospective analysis of the National Cancer Data Base (2010-2015).
- Inclusion of patients who underwent enterectomy with negative margins for SB-GIST.
- Categorization by tumor size (2.1-5 cm, 5.1-10 cm, >10 cm) and histologic grade (≤5 or >5 mitoses/50 HPF).
- Cox proportional hazard analysis to assess the impact of adjuvant therapy on overall survival.
Main Results:
- 1,559 patients met the inclusion criteria.
- Adjuvant therapy significantly improved overall survival in high-grade, intermediate, and large-sized tumors (P=.010 and P=.003, respectively).
- No survival benefit was observed for adjuvant therapy in small high-grade tumors or any low-grade tumors.
- Multivariable analysis confirmed adjuvant therapy was independently associated with reduced mortality risk for high-grade tumors (HR 0.37, 95% CI: 0.21-0.64).
Conclusions:
- Adjuvant therapy decisions for small bowel GIST should be individualized based on tumor size and grade.
- Careful consideration of tumor characteristics is crucial for optimizing adjuvant treatment strategies in SB-GIST.
