Z. E. Stiles1, P. V. Dickson1, M. G. Martin2, E. S. Glazer1, S. W. Behrman1, J. L. Deneve1 1University Of Tennessee Health Science Center,Department Of Surgery,Memphis, TN, USA 2West Cancer Center,Memphis, TN, USA
Introduction:
Potentially curative therapy for gastrointestinal stromal tumors (GISTs) involves surgical resection. Recently, it has been suggested that there is a subgroup of patients with small (≤ 2 cm) gastric GISTs that may undergo regular endoscopic surveillance in lieu of surgical resection given their likely indolent nature. The purpose of this study was to examine the pathologic and known prognostic features of tumors within this subgroup and to compare outcomes among patients undergoing resection at different time points.
Methods:
A retrospective review of the 2004 – 2014 National Cancer Database was performed. Patients with tumors ≤ 2 cm were compared to those with larger tumors with regard to clinical and pathologic features. Among tumors ≤ 2 cm, short and long term outcomes were then evaluated for patients undergoing surgical resection at different time periods: early (0 – 90 days), and late (> 90 days).
Results:
Patients with tumors ≤ 2 cm (n = 1732) were more often younger (median age 65 vs 66, p < 0.001), female (59.2% vs 49.8%, p < 0.001) and Caucasian (72.7% vs 68.2%, p = 0.001) compared to those with tumors > 2 cm (n = 10518). A smaller proportion of tumors ≤ 2 cm were found to be high grade (2.4% vs 11.0%, p < 0.001) and small tumors were less likely to be associated with distant metastases (2.5% vs 10.3%, p < 0.001). Among patients with tumors ≤ 2 cm, no significant differences were seen with regard to margin status, LOS, unplanned readmission, 30-day, or 90-day mortality based on the timing of surgical resection (all p > 0.4). Overall survival (OS) was favorable for all patients with tumors ≤ 2 cm as the median OS was not reached (NR) (mean 116.9 months). No difference in OS was observed based on the time from diagnosis to surgical resection (mean OS 117.8 months [95% CI 112.6 – 122.9] vs. 107.5 months [95% CI 84.4 – 130.6], log rank p = 0.804).
Conclusion:
In this large database, patients with small gastric GIST exhibited overall favorable findings compared to larger tumors. Delayed resection (> 90 days) was not associated with a negative impact on short term outcomes or overall survival for small gastric GIST. Prospective evaluation of a protocol involving longitudinal surveillance of small gastric GISTs is warranted.