Journal Article

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

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

2016

Overview

Background and Aims Gastrointestinal stromal tumors (GISTs) have significant variability in size and malignant behavior. Our current understanding is limited to pathological analyses, autopsy studies, and small case series. The aim of the current study is to define the risk factors, incidence, and mortality rates of GIST <2 cm in the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Methods Patients with histologically confirmed malignant GIST <2 cm were studied from 2001 to 2011. GIST was defined by GI tumor site codes and GIST-specific histology codes. Results We identified 378 patients with GIST <2 cm. The average age at diagnosis was 64.0 years with equal sex distribution. The most common tumor location was the stomach (62.2 %), followed by the small intestine (23.3 %), colon (5.6 %), and rectum (3.4 %). Most patients had localized disease (79.4 %), but 11.4 % had regional/distant metastatic disease. The annual incidence rate was 4.2 per 10,000,000 (10M). This was the highest among Blacks (7.6 per 10M). Among patients with GIST and no additional cancers, the 5-year GIST-specific mortality was 12.9 %. Moreover, there was a significantly increased 5-year GIST-specific mortality in those patients who had regionally advanced (34.0 %) or metastatic GIST (34.3 %), as compared to those patients with localized GIST (5.6 %). Conclusions This study represents the first population-based analysis of malignant GIST <2 cm. While quite rare, these tumors have an underappreciated disease-specific mortality. Further studies are needed to define the underlying reasons for the identified racial differences, to develop novel risk assessment schema for patients with these small tumors, and to determine appropriate indications for resection and/or medical therapy.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Asian - statistics & numerical data / Autopsies / Black or African American - statistics & numerical data / Cancer / Codes / Colon / Databases, Factual / Epidemiology / Female / Gastroenterology / Gastrointestinal Neoplasms - epidemiology / Gastrointestinal Neoplasms - mortality / Gastrointestinal Neoplasms - pathology / Gastrointestinal Stromal Tumors - epidemiology / Gastrointestinal Stromal Tumors - mortality / Gastrointestinal Stromal Tumors - secondary / Histology / Humans / Hyperplasia / Incidence / Intestine, Small / Male / Medicine / Medicine & Public Health / Metastasis / Middle Aged / Mortality / Mutation / Native Hawaiian or Other Pacific Islander - statistics & numerical data / Oncology / Original Article / Rectum / Risk Factors / SEER Program / Stomach / Surgery / Surveillance / Tumor Burden / Tumors / White People - statistics & numerical data / Young Adult