Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2021; 27(36): 6128-6141
Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6128
Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis
Hao Wu, Chen Li, Han Li, Liang Shang, Hai-Yan Jing, Jin Liu, Zhen Fang, Feng-Ying Du, Yang Liu, Meng-Di Fu, Ke-Wei Jiang, Le-Ping Li
Hao Wu, Liang Shang, Zhen Fang, Feng-Ying Du, Yang Liu, Le-Ping Li, Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Chen Li, Ke-Wei Jiang, Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
Han Li, Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan 250021, Shandong Province, China
Liang Shang, Le-Ping Li, Department of Digestive Tumor Translational Medicine, Engineering Laboratory of Shandong Province, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
Liang Shang, Le-Ping Li, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
Hai-Yan Jing, Department of Pathology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Jin Liu, Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Meng-Di Fu, Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Author contributions: All authors helped to perform the research; Wu H and Li C were involved equally in the conception and design; Li H provided clinical advice; Fu MD was involved in the follow-up of patients; Fang Z was involved in preliminary medical record screening and entry; Liu Y was involved in the verification of the included data; Du FY was involved in the drafting of the paper or revising it critically for intellectual content; Jing HY and Jiang KW provided pathology images and supervised the report; Shang L and Li LP were involved in the final approval of the version to be published; All authors agreed to be accountable for all aspects of the work.
Supported by Key Research and Development Program of Shandong Province, No. 2019JZZY010104 and No. 2019GSF108146; Special Foundation for Taishan Scholars Program of Shandong Province, No. ts20190978; and Academic Promotion Programme of Shandong First Medical University, No. 2019QL021.
Institutional review board statement: This study was designed in compliance with the Helsinki Declaration and approved by the Ethics Committee of Shandong Provincial Hospital (SWYX: No. 2021-035).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Le-Ping Li, MD, Full Professor, Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwuweiqi road, Huaiyin District, Jinan 250021, Shandong Province, China. lileping@sdu.edu.cn
Received: June 19, 2021
Peer-review started: June 19, 2021
First decision: July 14, 2021
Revised: July 26, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: September 28, 2021
Abstract
BACKGROUND

Multiple gastrointestinal stromal tumors (MGISTs) are specific and rare. Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors (GIST). The diagnosis, treatment and follow-up strategies of MGISTs is not specifically described in guidelines.

AIM

To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs (SGISTs)

METHODS

Patients diagnosed with primary GISTs from March 2010 to January 2020 were included. Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes, propensity score matching was performed according to comorbidities, body mass index, tumor location, mitotic index, sex, age and American Society of Anesthesiologists score. Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.

RESULTS

Among the entire cohort of 983 patients, the incidence of MGISTs was 4.17%. Before matching, patients with MGISTs and those with SGISTs had disparities in body mass index, surgical approach, tumor size and mitotic index. After 1:4 ratio matching, the clinical baseline data were comparable. The 5-year progression-free survival rate was 52.17% in the MGIST group and 75.00% in the SGIST group (P = 0.031). On multivariate analysis, tumor location, tumor size, mitotic index, imatinib treatment and MGISTs (hazard ratio = 2.431, 95% confidence interval = 1.097-5.386, P = 0.029) were identified as independent prognostic factors of progression-free survival. However, overall survival was similar between the SGIST and MGIST groups.

CONCLUSION

Patients with MGISTs had poorer progression-free survival than patients with SGISTs. Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.

Keywords: Gastrointestinal stromal tumors, Synchronous, Multiple tumors, Solitary tumor, Propensity score matching, Prognosis

Core Tip: Whether the clinicopathological characteristics and long‑term survival of patients with multiple gastrointestinal stromal tumors are different from those of patients with solitary gastrointestinal stromal tumors is unclear. This is the first study to compare and describe these features. For accuracy and clarity, propensity score matching was used to balance the differences to explore the prognostic factors for patients with multiple gastrointestinal stromal tumors. To date, this study has the most detailed data and the largest number of patients, which may bring new insight to the diagnosis and treatment of multiple gastrointestinal stromal tumors.