The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors

Hamda Almaazmi, Miloslawa Stem, Brian D. Lo, James P. Taylor, Sandy H Fang, Bashar Safar, Jonathan Efron, Chady Atallah

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. Methods: Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004–2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. Results: A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009–2015: adjusted HR [AHR] 0.73, 95% CI 0.59–0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19–1.53; 10-year AHR 1.23, 95% CI 1.09–1.38; each p < 0.001). Conclusion: CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Gastrointestinal Stromal Tumors
Colorectal Neoplasms
Survival
Therapeutics
Imatinib Mesylate
Drug Therapy
Neoplasms
Kaplan-Meier Estimate
Proportional Hazards Models
Databases

Keywords

  • Chemotherapy
  • Colorectal
  • Gastrointestinal stromal tumor
  • GIST
  • Imatinib
  • Small bowel

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{0f5043a0b688429b8dfd6a9c8aa15caf,
title = "The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors",
abstract = "Background: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. Methods: Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004–2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. Results: A total of 8441 cases were included (SB 81.66{\%}; CR 18.34{\%}). Radical resection was the most common treatment (SB 42.33{\%}; CR 38.69{\%}). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43{\%}; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009–2015: adjusted HR [AHR] 0.73, 95{\%} CI 0.59–0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83{\%} and 47.68{\%}; CR 61.33{\%} and 45.39{\%}; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95{\%} CI 1.19–1.53; 10-year AHR 1.23, 95{\%} CI 1.09–1.38; each p < 0.001). Conclusion: CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.",
keywords = "Chemotherapy, Colorectal, Gastrointestinal stromal tumor, GIST, Imatinib, Small bowel",
author = "Hamda Almaazmi and Miloslawa Stem and Lo, {Brian D.} and Taylor, {James P.} and Fang, {Sandy H} and Bashar Safar and Jonathan Efron and Chady Atallah",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11605-019-04344-4",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors

AU - Almaazmi, Hamda

AU - Stem, Miloslawa

AU - Lo, Brian D.

AU - Taylor, James P.

AU - Fang, Sandy H

AU - Safar, Bashar

AU - Efron, Jonathan

AU - Atallah, Chady

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. Methods: Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004–2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. Results: A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009–2015: adjusted HR [AHR] 0.73, 95% CI 0.59–0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19–1.53; 10-year AHR 1.23, 95% CI 1.09–1.38; each p < 0.001). Conclusion: CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.

AB - Background: The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. Methods: Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004–2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. Results: A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009–2015: adjusted HR [AHR] 0.73, 95% CI 0.59–0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19–1.53; 10-year AHR 1.23, 95% CI 1.09–1.38; each p < 0.001). Conclusion: CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.

KW - Chemotherapy

KW - Colorectal

KW - Gastrointestinal stromal tumor

KW - GIST

KW - Imatinib

KW - Small bowel

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