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Wang Q, Li M, Bai X, Zhang R, Ruan S, Ou C, Li J, Li J. Unraveling the site-specific features in small intestinal stromal tumors: a retrospective study. BMC Gastroenterol 2025; 25:337. [PMID: 40335936 PMCID: PMC12057284 DOI: 10.1186/s12876-025-03945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 04/28/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are a rare and less well-characterized disease. There is limited information on the clinical features of small intestinal GISTs at different sites. AIMS To enhance the understanding of the clinical characteristics and disease behavior of small intestinal GISTs based on their sites. METHODS We conducted a retrospective review of medical records for 317 patients diagnosed with primary small intestinal GISTs confirmed by surgical pathology, comparing their clinical features and tumor characteristics. RESULTS According to this cohort's data, duodenal GISTs presented with longer disease durations and higher prevalence of melena (44.6%), while jejunal GISTs manifested as abdominal masses (11.5%) and acute gastrointestinal bleeding (GIB) (13.3%), with the highest rate of emergency surgeries (16.8%). Ileal GISTs were associated with an older age of onset and a higher prevalence of hematochezia (19.6%), with one-third of cases discovered incidentally during gynecological procedures. Notably, the biological behavior of small intestinal GISTs varied significantly by sites. Tumors demonstrated different immunochemical markers and a progressive increase in diameter, mitotic activity, T and M stages, and risk classification from the duodenum to the jejunum and ileum. These findings warrant further validation in prospective multicenter studies. CONCLUSIONS Small intestinal GISTs might exhibit distinct clinical presentations and oncological features depending on their sites.
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Affiliation(s)
- Qipu Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Muhan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Ruishi Zhang
- Guanghua School of Management, Peking University, Beijing, 100871, China
| | - Suaizhi Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Chengzhu Ou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China.
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China.
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Bai S, Sun Y, Xu H. Impact of Gastrointestinal Bleeding on Prognosis and Associated Risk Factors in Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis. Am Surg 2025; 91:434-443. [PMID: 39673549 DOI: 10.1177/00031348241307402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2024]
Abstract
BackgroundGastrointestinal stromal tumors (GISTs) are common mesenchymal tumors of the digestive tract. The impact of gastrointestinal bleeding on the prognosis of GISTs remains controversial. This study aims to evaluate the prognostic significance of gastrointestinal bleeding in GIST patients and analyze associated risk factors.MethodsA systematic review and meta-analysis were conducted according to the PRISMA guidelines. PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane Library databases were searched for relevant studies published up until December 31, 2023. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was used to estimate the relationship between gastrointestinal bleeding and prognosis. Subgroup analyses were performed based on bleeding location and other risk factors.ResultsTwelve studies involving 3475 patients were included. Gastrointestinal bleeding significantly affected the prognosis of GIST patients, including recurrence-free survival (RFS) (HR = 1.57, 95% CI: 0.98-2.52, P < .01) and overall survival (OS) (HR = 3.04, 95% CI: 1.33-6.97, P < .01). Patients with gastric GIST bleeding had significantly worse prognoses (HR = 4.37, 95% CI: 2.36-8.11, P < .01), while small intestinal bleeding showed no significant difference. The bleeding risk was lower in the small intestine compared to the stomach (HR = .63, 95% CI: 0.48-0.83, P < .01). Age under 65, male gender, tumor size ≥5 cm, and mitotic index ≥5 HPF were identified as high-risk factors for GIST bleeding.ConclusionsGastrointestinal bleeding significantly impacts the prognosis of GIST patients, particularly in those with gastric bleeding.
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Affiliation(s)
- Shuchen Bai
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yefei Sun
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Xu
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
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Yang J, Guo P, Zhang Z, Lu C, Qiao Z. The impact of gender on survival outcomes in patients with small intestinal stromal tumors: a comprehensive analysis using the SEER database. Surg Endosc 2024; 38:3905-3916. [PMID: 38831215 DOI: 10.1007/s00464-024-10942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Small intestinal stromal tumors (SISTs) are a rare type of mesenchymal tumor. Gender is known to influence the incidence and prognosis of various tumors, but its role on the survival of SISTs at the population level remains unclear. Therefore, we aim to explore the relationship between gender and the prognosis of SISTs using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Data on SISTs patients from 2000 to 2019 were derived from the SEER database. Multiple imputation was used to address missing data. Kaplan-Meier analyses and Cox proportional hazard models were applied to evaluate the impact of demographic and clinical characteristics on overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 3513 patients with SISTs were analyzed, including 1921 males and 1592 females. Kaplan-Meier analysis coupled with log-rank testing demonstrated a significantly higher mortality rate among male patients compared to females (P < 0.001). Notably, female patients exhibited superior OS (hazard ratio [HR] 0.808, 95% confidence interval [CI] 0.724-0.902, P < 0.001) and CSS (HR 0.801, 95% CI 0.692-0.927, P = 0.003) compared to male patients. While the mean 1-year CSS rates were comparable between genders (95.3% for males vs. 96.0% for females, P = 0.332), male patients consistently showed lower mean survival rates at 3-, 5-, and 10-year intervals. Surgical intervention significantly boosted 5-year OS and CSS rates in both male and female patients (P < 0.001). Multivariate Cox regression analysis identified age, sex, grade, TNM stage, surgery, and mitotic rate as independent risk factors for OS and CSS in patients with SISTs. CONCLUSIONS Our findings suggest that male patients with SISTs have a higher risk of mortality compared to female patients, indicating that gender may serve as a predictive indicator for survival in this patient population.
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Affiliation(s)
- Jun Yang
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Ping Guo
- Department of Internal Medicine, Dianshan Lake People's Hospital, Suzhou, China
| | - Zhi Zhang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Chengjie Lu
- Department of Traditional Chinese Medicine, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
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Dhaliwal LS, Grewal US, Chandar AK, Mangla A, Zia H. Characteristics and outcomes with or without gastrointestinal bleeding in patients with gastrointestinal stromal tumors. Eur J Gastroenterol Hepatol 2023; 35:1306-1307. [PMID: 37773779 DOI: 10.1097/meg.0000000000002634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Lovekirat S Dhaliwal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Udhayvir S Grewal
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Apoorva K Chandar
- Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, University Hospitals Cleveland Medical Center
| | - Ankit Mangla
- Division of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hassan Zia
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Shi X, Chen Z, Shou C, Bai H, Yang W, Zhang Q, Liu X, Yu J. The prognostic role of gastrointestinal bleeding in patients with a primary gastrointestinal stromal tumor: a long-term follow-up study. J Gastrointest Oncol 2023; 14:2028-2038. [PMID: 37969844 PMCID: PMC10643578 DOI: 10.21037/jgo-22-1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/07/2023] [Indexed: 11/17/2023] Open
Abstract
Background Gastrointestinal (GI) bleeding is one of the common symptoms of GI stromal tumor (GIST). Although several studies have highlighted its prognostic role, conclusions have been inconsistent. This study aimed to investigate the prognosis of GIST patients with GI bleeding. Methods Primary GIST patients who underwent complete resection and did not receive adjuvant imatinib therapy from January 2003 to December 2008 were reviewed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and multivariate analysis was performed using the Cox proportional hazard model. Propensity score matching (PSM) was conducted to reduce confounders. A systematic review of the published articles in the PubMed, Embase, Cochrane Collaboration, and Medline databases was also conducted, and the inclusion criteria were determined using PICOS (patients, intervention, comparison, outcomes, and study design) principles. Results In total, 84 patients presenting with GI bleeding and 90 patients without GI bleeding were enrolled in this study. The median time of follow-up was 140 months (range, 10-196 months), and 38 patients developed tumor recurrence/metastasis. For all patients, the multivariate analysis indicated that tumor location [hazard ratio (HR) =3.48, 95% confidence interval (CI): 1.78-6.82, P<0.001], tumor size (HR =1.91, 95% CI: 1.05-3.47, P=0.035), mitotic index (MI; HR =5.69, 95% CI: 2.77-11.67, P<0.001), and age (HR =2.68, 95% CI: 1.49-4.82, P=0.001) were the independent prognostic factors for poor RFS. However, GI bleeding was not associated with RFS (HR =1.21, 95% CI: 0.68-2.14, P=0.518). After PSM, 45 patients from each group were included, and it was found that GI bleeding was still not the independent prognostic factor (HR =1.23, 95% CI: 0.51-2.97, P=0.642). Moreover, the pooled results of our study and six previously reported studies showed that GI bleeding was not the independent prognostic factor (HR =1.45, 95% CI: 0.73-2.86, P=0.287). Conclusions In this study, tumor location, tumor size, MI, and age were independent prognostic factors in primary GIST patients who underwent radical resection. However, GI bleeding was not associated with worse RFS.
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Affiliation(s)
- Xiaoxiao Shi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhou Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunhui Shou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Weili Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaosun Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiren Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Huang PH, Chen YY, Chen HH, Ting WH, Lin HH, Chen KH, Hsiao SM. Factors affecting clinical outcomes in women with non-gastric gastrointestinal stromal tumors. Taiwan J Obstet Gynecol 2022; 61:306-311. [DOI: 10.1016/j.tjog.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/26/2022] Open
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Minhem MA, Nakshabandi A, Mirza R, Alsamman MA, Mattar MC. Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions. World J Gastrointest Endosc 2021; 13:391-406. [PMID: 34630889 PMCID: PMC8474699 DOI: 10.4253/wjge.v13.i9.391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemorrhage (GIH) is a common complication with gastrointestinal cancers (GIC). There is no comprehensive research that examines GIH in different types of GIC. AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC. METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients (≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality. RESULTS Out of a total of 18173885 inpatients, 321622 (1.77%) cases had a diagnosis of GIC. Within GIC patients, 30507 (9.5%) inpatients had GIH, which was significantly (P < 0.001) more than the prevalence of GIH in patients without GIC (3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer (15.7%), liver cancer (13.0%), small bowel cancer (12.7%), esophageal cancer (9.1%), colorectal cancer (9.1%), pancreatic cancer (7.2%), bile duct cancer (6.0%), and gallbladder cancer (5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate (15.6%) than jejunal (11.1%) and ileal cancers (5.7%). Within esophageal cancers, lower third cancers had higher GIH (10.7%) than the middle third (8.0%) or upper third cancers (6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances (Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis (P < 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios (OR) = 0.74 (0.72-0.77), P < 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267 (53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42 (0.38-0.46), P < 0.001]. CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor's anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.
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Affiliation(s)
- Mohamad A Minhem
- Internal Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Ahmad Nakshabandi
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Rabia Mirza
- School of Medicine, Georgetown University, Washington, DC 20007, United States
| | - Mohd Amer Alsamman
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark C Mattar
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
- School of Medicine, Georgetown University, Washington, DC 20007, United States
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Fan X, Han H, Sun Z, Zhang L, Chen G, Mzee SAS, Yang H, Chen J. Prognostic Value of Bleeding in Gastrointestinal Stromal Tumors: A Meta-Analysis. Technol Cancer Res Treat 2021; 20:15330338211034259. [PMID: 34323156 PMCID: PMC8330451 DOI: 10.1177/15330338211034259] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Gastrointestinal bleeding is the most common clinical manifestation of gastrointestinal stromal tumor. It is of great significance to the prognosis of patients. But the results are controversial. The purpose of this study was to evaluate the relationship between gastrointestinal bleeding and clinical prognosis in patients with GIST. Methods: A systematic literature search was performed in Pumbed, Cochrane Library, EMBASE, ClinicalTrials.gov, CNKI, VIP and wanfang databases with the pattern of unlimited languages. 12 studies with 2781 individuals were included in the final analysis. The overall survival (OS), recurrence-free survival/disease-free survival (RFS/DFS) and related factors affecting bleeding in patients with gastrointestinal stromal tumor (GIST) were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were used for in the meta-analysis. Results: A total of 12 articles were included in the study, including 2781 patients with GIST, including 845 patients with gastrointestinal bleeding. The OS of GIST patients with gastrointestinal bleeding was significantly worse (HR = 2.54, 95% CI = 1.13-5.73, P = 0.025). But there was no significant difference in RFS between gastrointestinal bleeding patients and non-bleeding patients (HR = 1.35, 95% CI = 0.70-2.61, P = 0.371). Further analysis of the related factors of GI bleeding in GIST patients was observed, besides the aging factor (HR = 1.02, 95% CI = 0.69-1.50, P = 0.929), Small intestinal stromal tumor (HR = 0.56, 95% CI = 0.41-0.76, P < 0.001), tumor diameter ≥ 5 cm (HR = 2.09, 95% CI = 1.20-3.63, P = 0.009), Mitotic index ≥ 5/50 HPF (HR = 1.66, 95% CI = 1.11-2.49, P = 0.014) and tumor rupture (HR = 2.04, 95% CI = 1.0-3.82, P = 0.026) all increased the risk of GI bleeding in patients with GIST. Conclusions: The OS of GIST patients with GI bleeding was worse than non-GI bleeding, but had no significant effect on RFS. Nevertheless the aging factor, the location of GIST in the small intestine, tumor diameter ≥ 5 cm, Mitotic index ≥ 5/50 HPF and tumor rupture all increased the risk of GI bleeding in patients with GIST.
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Affiliation(s)
- Xin Fan
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - He Han
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhiyu Sun
- Medical College, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Liwen Zhang
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Gong Chen
- Medical College, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Said Abdulrahman Salim Mzee
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hanqing Yang
- 567917Wujin People's Hospital, Changzhou, Jiangsu, China
| | - Jixiang Chen
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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Wan W, Zheng B, Sun W, Wang J, Shen S, Huang L, Liu H, Ni X, Liu H. Adjuvant Therapy in Resected Nonmetastatic Stage II-IV Gallbladder Cancer: A Generalized Propensity Score Analysis. Oncol Res Treat 2021; 44:390-399. [PMID: 34218220 DOI: 10.1159/000517113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical benefits and efficacies of adjuvant therapies for gallbladder cancer (GBC) have not been verified due to insufficient clinical evidence. METHODS Patients with resected nonmetastatic stage II-IV GBC were selected from the Surveillance, Epidemiology, and End Results database and distributed into nonchemotherapy and chemoradiotherapy (NCRT), chemotherapy (CT), and chemoradiotherapy (CRT) groups. Generalized propensity score and inverse probability of treatment weighting (IPTW) were used to reduce the imbalances between groups. RESULTS A total of 2,689 patients were enrolled, among whom 1,193 (44.4%) were classified as stage II, 1,371 (51.0%) as stage III, and 125 (4.6%) as stage IV GBC. A total of 1,703, 444, and 542 patients were placed in the NCRT, CT, and CRT groups, respectively. After the IPTW, there were no significant differences in overall survival (OS) between the 3 treatment groups (p > 0.05) in stage II GBC patients. In patients with stage III-IV GBC, the CT group exhibited a superior OS compared to the NCRT group (p < 0.001). In addition, the CRT group exhibited a superior OS compared to the CT (p < 0.001) and NCRT (p < 0.001) groups. For patients with stage III-IV tumors, a nomogram was constructed to predict the survival benefits of adjuvant therapies. CONCLUSION Patients with stage II GBC may not benefit from adjuvant therapy, while patients with stage III-IV GBC were shown to benefit from chemotherapy and chemoradiotherapy. Furthermore, chemoradiotherapy exhibited a superior OS. Nevertheless, the results need to be explained in the context of retrospective studies.
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Affiliation(s)
- Wenze Wan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China,
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Bohao Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wentao Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiwen Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lihong Huang
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaojian Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
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Small bowel gastrointestinal stromal tumor presenting with gastrointestinal bleeding in patient with type 1 Neurofibromatosis: Management and laparoscopic treatment. Case report and review of the literature. Int J Surg Case Rep 2021; 79:84-90. [PMID: 33444965 PMCID: PMC7808908 DOI: 10.1016/j.ijscr.2020.12.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. It may be asymptomatic; nevertheless, gastrointestinal bleeding is the most frequent symptom, due to mucosal erosion. Its poor lymph node metastatic spread makes GIST often suitable of minimally invasive surgical approach. The importance of this study is to increase the awareness among physicians about this condition in particular scenarios as in our case and to stress the role of laparoscopic surgery. CASE PRESENTATION A 74-year-old female patient presented to the emergency department with hematemesis, followed by haematochezia and melena. The patient had a medical history of type 1 Neurofibromatosis (NF1). She underwent, after CT scan, esophagogastroduodenoscopy, and endoscopic haemostasis. Finally, we performed a laparoscopic resection of a mass of the first jejunal loop. The postoperative period was predominantly uneventful. Pathological examination confirmed a low-risk GIST. CLINICAL DISCUSSION Proximal jejunal GIST may cause an upper and lower gastrointestinal bleeding. A multidisciplinary team approach is mandatory for the correct management of this disease and its complications (bleeding). GISTs are indicated as the most commonly gastrointestinal NF1 associated tumours. In case of localised and resectable GIST surgical treatment is the mainstay and laparoscopic surgery is a valid alternative. CONCLUSION In case of abdominal bleeding mass in a NF1 patient, it is important to keep in mind the well-known association between NF1 and GIST to facilitate the diagnosis and to quickly perform the appropriate treatment. Laparoscopic approach is safe and effective if the oncological radicality is respected.
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Perisetti A, Goyal H, Tharian B. Role of TC-325 in GI tumor hemostasis. Gastrointest Endosc 2020; 92:793-794. [PMID: 32838916 DOI: 10.1016/j.gie.2020.03.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Abhilash Perisetti
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hemant Goyal
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Rong J, Chen S, Song C, Wang H, Zhao Q, Zhao R, He Y, Yan L, Song Y, Wang F, Xie Y. The prognostic value of gender in gastric gastrointestinal stromal tumors: a propensity score matching analysis. Biol Sex Differ 2020; 11:43. [PMID: 32703269 PMCID: PMC7376864 DOI: 10.1186/s13293-020-00321-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) of the stomach are the most common GISTs. The risk, incidence, and outcome of cancer are different between the sexes. Whether gender is related to the prognosis of gastric stromal tumors is unclear. Therefore, this study aims to explore the relationship between gender and gastric GIST prognosis. Methods Data from gastric GIST patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce confounding factors, and the clinicopathological features and prognosis of GIST patients were comprehensively evaluated. Results There were 512 male patients and 538 female patients with gastric GIST. The gender of gastric GIST patients was associated with marital status, surgical treatment, tumor size, and mitotic index (P < 0.05). The Kaplan-Meier analysis and log-rank test revealed that male patients had a higher mortality rate than female patients (P = 0.0024). After matching all the potential confounding factors, the survival of the female gastric GIST patients was better than that of the male gastric GIST patients (P = 0.042). Cox regression analysis revealed that gender was an independent risk factor for overall survival. The risk of death was higher for males than for females (HR 1.677, 95% CI 1.150–2.444, P = 0.007). Conclusion Gender could be a prognostic factor for gastric GIST survival, and male patients had a higher risk of death.
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Affiliation(s)
- Jianfang Rong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Sihai Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Conghua Song
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.,Department of Gastroenterology, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Huan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Qiaoyun Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Rulin Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Yajing He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Lili Yan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.,School of Pharmacy, Nanchang University, Nanchang, China
| | - Yanping Song
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Fangfei Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Yong Xie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China. .,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China. .,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.
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Abstract
Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.
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Affiliation(s)
- Benjamin M Skoch
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Christian T Sinclair
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA. https://twitter.com/ctsinclair
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Wan W, Xiong Z, Zeng X, Yang W, Li C, Tang Y, Lin Y, Gao J, Zhang P, Tao K. The prognostic value of gastrointestinal bleeding in gastrointestinal stromal tumor: A propensity score matching analysis. Cancer Med 2019; 8:4149-4158. [PMID: 31197969 PMCID: PMC6675735 DOI: 10.1002/cam4.2328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/12/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background and objectives Whether gastrointestinal (GI) bleeding indicates gastrointestinal stromal tumor (GIST) rupture and impacts prognosis is unclear. We examined the prognostic value of GI bleeding in GIST. Methods Primary GIST patients with (GB group) or without (NGB group) initial symptoms of GI bleeding were retrospectively studied. Propensity score matching (PSM) was conducted to reduce confounders. Results Eight hundred patients were enrolled. Male gender [odds ratio (OR) = 1.517, P = 0.011], tumors in the small intestine (OR = 2.539, P < 0.001), and tumor size 5‐10 cm (OR = 2.298, P = 0.004) increased the odds of GI bleeding; age >60 years decreased the odds (OR = 0.683, P = 0.031). After PSM, 444 patients were included (222 in each group). Relapse‐free survival (RFS) (P = 0.001) and overall survival (OS) (P = 0.002) were both superior in the GB group. In subgroup analysis, the GB group achieved a superior RFS (P = 0.005) and OS (P = 0.007) in patients with small intestine GIST, but not stomach or colorectal GIST. Conclusions GIST patients with age <60, male gender, tumors located in the small intestine, and tumors 5‐10 cm in size had a higher risk of GI bleeding. GIST patients with GI bleeding had a superior RFS and OS. This difference was statistically significant only in small intestine GIST.
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Affiliation(s)
- Wenze Wan
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Xiong
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Zeng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenchang Yang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengguo Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Tang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Lin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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