Clinicopathological Outcomes and Prognosis of Elderly Patients (≥ 65 Years) with Gastric Gastrointestinal Stromal Tumors (GISTs) Undergoing Curative-Intent Resection: a Multicenter Data Review

Yang, Zifeng; Feng, Xingyu; Zhang, Peng; Chen, Tao; Qiu, Haibo; Zhou, Yongjian; Du, Chunyan; Yin, Xiaonan; Pan, Fang Ting; Zheng, Guoliang; Liu, Xiufeng; Huang, Chang‐Ming; Zhou, Zhiwei; Li, Guoxin; Tao, Kaixiong; Li, Yong

doi:10.1007/s11605-018-3944-1

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Additionally, younger patients (<65 years old) and older patients (≥65 years old) simultaneously showed a marginal trend toward a favorable survival duration when they perform surgery, and the finding is supported by interaction tests in this subgroup analysis. However, similar to previously published reports (35), our multivariable analysis suggests that older age was an important prognostic factor that could increase the risk of overall death or cancerspecific death. This observation might be the result of poorer physiologic reserves and capability to sustain more invasive treatment in the elderly.…”

Section: Logistic Regression On Patient Selection For Surgerysupporting

confidence: 90%

Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

et al. 2020

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Background: Surgery has been the primary treatment in patients with localized gastrointestinal stromal tumors (GISTs) for many decades, whereas it remains controversial regarding the efficacy of primary tumor resection for metastatic GISTs treated with chemotherapy, and likewise it is unclear who would benefit from the surgical resection. Methods: GISTs patients with distant metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of surgery on survival. Results: In total, of 455 patients with metastatic GISTs, 235 patients (51.6%) underwent primary tumor resection and 220 patients (48.4%) did not. Median survival of patients in resection group was 72 (95% CI: 62.90-81.10) months vs. 40 (95% CI: 29.53-50.47) months for those in non-resection group (p < 0.001). Similarly, surgery in conjunction with chemotherapy led to a favorable impact on survival than chemotherapy alone (OS: 72 vs. 40 months, p < 0.001; CSS: 74 vs. 44 months, p < 0.001). Multivariable analysis showed that both OS (HR: 0.581, 95% CI: 0.386-0.874, p = 0.009) and CSS (HR: 0.663, 95% CI: 0.439-0.912, p = 0.042] were dramatically improved in patients with surgical removal of primary site, as well as primary tumor size between 5 and 10 cm, while increasing age was predictive of poorer survival. Stratified analysis revealed that patients with tumor locations in the stomach demonstrated a prolonged survival after surgery, with no significant differential surgical effect between the stomach and small intestine. Conclusions: Our study preliminarily suggests that carefully selected patients with metastatic GISTs might prolong survival after treatment of surgery, especially those with a primary tumor between 5 and 10 cm and a tumor located in the stomach.

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Section: Logistic Regression On Patient Selection For Surgerysupporting

confidence: 90%

Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

et al. 2020

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“…Fewer patients from the older group received adjuvant therapy (30 vs. 66.8%; p = 0.001). Older patients had a higher rate of tumor necrosis and worse DFS and OS than younger patients [75].…”

Section: Real-world Experience With a Focus On The Older Patient Populationmentioning

confidence: 87%

“…Yang et al [75] analyzed the clinicopathological and prognostic data from 1846 patients with primary gastric GIST. They compared data from younger patients (n = 1264) and those aged ≥ 65 years (n = 582).…”

Section: Real-world Experience With a Focus On The Older Patient Populationmentioning

confidence: 99%

Treatment of Metastatic Gastrointestinal Stromal Tumors (GIST): A Focus on Older Patients

et al. 2021

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Gastrointestinal stromal tumors (GIST) originating in the Cajal cells are the most common mesenchymal neoplasms of the gastrointestinal tract. The median age of patients with this diagnosis is 65 years, and over 20% of cases affect people over the age of 70 years. The effectiveness and tolerability of systemic treatment with tyrosine kinase inhibitors in older patients with GIST seem to be similar to that in younger patients, but some studies have shown that treatment of older patients is suboptimal. Disability, frailty, comorbidities, and concomitant medications may influence treatment decisions, and toxicities also more often lead to treatment discontinuation. The known safety profile and oral administration route of the tyrosine kinase inhibitors used in GIST may allow maximization of treatment and the best efficacy, especially in older patients. This review summarizes the efficacy data for the systemic treatment of GIST, including data for older patients and from real-world experiences, if available and significant. The reported safety data and general rules for toxicity management, including appropriate patient selection and the need for careful monitoring during treatment, are also discussed.

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“…However, it has been reported that age may impact treatment outcomes and there is a trend toward more postoperative complications in elderly patients [ 43 ]. Yang et al indicated that elderly patients had more postoperative complications when compared with nonelderly patients [ 44 ]. This phenomenon can be explained by the fact that a high number of elderly patients underwent open surgery in that study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that age is an important risk factor for predicting gastric GISTs and that elderly patients tend to have a poor prognosis [ 32 , 44 , 45 ]. In contrast, some studies have shown that age is not a sensitive clinical predictor for determining the prognosis for GISTs [ 26 , 46 – 48 ], which indicated that the Charlson comorbidity index, prognostic nutritional index, tumor size, and proliferative index could be significant prognostic factors for predicting the prognosis of patients with GISTs.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Resection for Small Gastric Gastrointestinal Stromal Tumors in Elderly Patients

Cai

Yang

Ren

et al. 2022

Gastroenterology Research and Practice

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Background. Gastrointestinal stromal tumors (GISTs) are prevalent in elderly patients. Endoscopic resection has become popular for treating small (≤5 cm) gastric GISTs. However, little is known about the outcomes of endoscopic resection in elderly patients. Aim. To assess the efficacy and safety of endoscopic resection for small (≤5 cm) gastric GISTs in elderly patients (≥65 years old). Methods. A total of 260 patients (265 lesions) with gastric GISTs treated via endoscopic resection from January 2011 to May 2020 were retrospectively analyzed. Among them, 65 patients were ≥65 years old (elderly group), and 195 patients were <65 years old (nonelderly group). Clinicopathological characteristics, postoperative complications, and tumor recurrence rates between the two age groups were compared. Results. A total of 260 patients with primary small (≤5 cm) gastric GISTs were treated with endoscopic resection. The median ages of the elderly and nonelderly groups were 68 (range 65-83) years and 55 (range 32-64) years, respectively. Elderly patients showed a higher incidence of comorbidities compared with nonelderly patients (61.5% versus 32.3%s, respectively; p < 0.001 ). All elderly patients and 99.0% of nonelderly patients underwent en bloc resection; only two nonelderly patients received piecemeal resection. No significant differences were found regarding postoperative complications or tumor recurrence rates between the two groups. Conclusions. Although elderly patients had more comorbidities than nonelderly patients, both groups had similar postoperative complications and recurrence rates. We suggest that endoscopic resection performed by experienced endoscopists is safe and effective for treating small (≤5 cm) gastric GISTs in elderly patients.

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Clinicopathological Outcomes and Prognosis of Elderly Patients (≥ 65 Years) with Gastric Gastrointestinal Stromal Tumors (GISTs) Undergoing Curative-Intent Resection: a Multicenter Data Review

Cited by 9 publications

References 24 publications

Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

Treatment of Metastatic Gastrointestinal Stromal Tumors (GIST): A Focus on Older Patients

Efficacy and Safety of Endoscopic Resection for Small Gastric Gastrointestinal Stromal Tumors in Elderly Patients

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