Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort

Nikki S IJzerman; Mahmoud Mohammadi; Dimitri Tzanis; Hans Gelderblom; Marco Fiore; Elena Fumagalli; Piotr Rutkowski; Elzbieta Bylina; Ioannis Zavrakidis; Neeltje Steeghs; Han J Bonenkamp; Boudewijn van Etten; Dirk J Grünhagen; Shahnawaz Rasheed; Paris Tekkis; Charles Honoré; Winan van Houdt; Jos van der Hage; Sylvie Bonvalot; Yvonne Schrage; Myles Smith

doi:10.1016/j.ejso.2020.02.033

Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort

Nikki S IJzerman^*, Mahmoud Mohammadi, Dimitri Tzanis, Hans Gelderblom, Marco Fiore, Elena Fumagalli, Piotr Rutkowski, Elzbieta Bylina, Ioannis Zavrakidis, Neeltje Steeghs, Han J Bonenkamp, Boudewijn van Etten, Dirk J Grünhagen, Shahnawaz Rasheed, Paris Tekkis, Charles Honoré, Winan van Houdt, Jos van der Hage, Sylvie Bonvalot, Yvonne SchrageMyles Smith

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach.

METHODS: All rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses.

RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048).

CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.

Original language	English
Pages (from-to)	1124-1130
Number of pages	7
Journal	European Journal of Surgical Oncology
Volume	46
Issue number	6
Early online date	5 Mar 2020
DOIs	https://doi.org/10.1016/j.ejso.2020.02.033
Publication status	Published - 1 Jun 2020

Bibliographical note

Funding:
A research grant for the Dutch GIST Registry was received from
Novartis (3017/13), Pfizer (WI189378) and Bayer (2013-MED12005). These funding sources did not have any involvement in
conducting this research.

Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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IJzerman, N. S., Mohammadi, M., Tzanis, D., Gelderblom, H., Fiore, M., Fumagalli, E., Rutkowski, P., Bylina, E., Zavrakidis, I., Steeghs, N., Bonenkamp, H. J., van Etten, B., Grünhagen, D. J., Rasheed, S., Tekkis, P., Honoré, C., van Houdt, W., van der Hage, J., Bonvalot, S., ... Smith, M. (2020). Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort. European Journal of Surgical Oncology, 46(6), 1124-1130. https://doi.org/10.1016/j.ejso.2020.02.033

@article{f53eaec82ba24ec7a48a46afcd8c842e,

title = "Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort",

abstract = "BACKGROUND: Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach.METHODS: All rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses.RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65\%) and/or adjuvant imatinib therapy (66\%). Local recurrence rate after surgery was 15\% and overall recurrence rate 28\%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048).CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.",

author = "IJzerman, \{Nikki S\} and Mahmoud Mohammadi and Dimitri Tzanis and Hans Gelderblom and Marco Fiore and Elena Fumagalli and Piotr Rutkowski and Elzbieta Bylina and Ioannis Zavrakidis and Neeltje Steeghs and Bonenkamp, \{Han J\} and \{van Etten\}, Boudewijn and Gr{\"u}nhagen, \{Dirk J\} and Shahnawaz Rasheed and Paris Tekkis and Charles Honor{\'e} and \{van Houdt\}, Winan and \{van der Hage\}, Jos and Sylvie Bonvalot and Yvonne Schrage and Myles Smith",

note = "Funding: A research grant for the Dutch GIST Registry was received from Novartis (3017/13), Pfizer (WI189378) and Bayer (2013-MED12005). These funding sources did not have any involvement in conducting this research. Copyright {\textcopyright} 2020 Elsevier Ltd, BASO \textasciitilde{} The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.",

year = "2020",

month = jun,

day = "1",

doi = "10.1016/j.ejso.2020.02.033",

language = "English",

volume = "46",

pages = "1124--1130",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

number = "6",

}

IJzerman, NS, Mohammadi, M, Tzanis, D, Gelderblom, H, Fiore, M, Fumagalli, E, Rutkowski, P, Bylina, E, Zavrakidis, I, Steeghs, N, Bonenkamp, HJ, van Etten, B, Grünhagen, DJ, Rasheed, S, Tekkis, P, Honoré, C, van Houdt, W, van der Hage, J, Bonvalot, S, Schrage, Y & Smith, M 2020, 'Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort', European Journal of Surgical Oncology, vol. 46, no. 6, pp. 1124-1130. https://doi.org/10.1016/j.ejso.2020.02.033

TY - JOUR

T1 - Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort

AU - IJzerman, Nikki S

AU - Mohammadi, Mahmoud

AU - Tzanis, Dimitri

AU - Gelderblom, Hans

AU - Fiore, Marco

AU - Fumagalli, Elena

AU - Rutkowski, Piotr

AU - Bylina, Elzbieta

AU - Zavrakidis, Ioannis

AU - Steeghs, Neeltje

AU - Bonenkamp, Han J

AU - van Etten, Boudewijn

AU - Grünhagen, Dirk J

AU - Rasheed, Shahnawaz

AU - Tekkis, Paris

AU - Honoré, Charles

AU - van Houdt, Winan

AU - van der Hage, Jos

AU - Bonvalot, Sylvie

AU - Schrage, Yvonne

AU - Smith, Myles

N1 - Funding: A research grant for the Dutch GIST Registry was received from Novartis (3017/13), Pfizer (WI189378) and Bayer (2013-MED12005). These funding sources did not have any involvement in conducting this research. Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

PY - 2020/6/1

Y1 - 2020/6/1

N2 - BACKGROUND: Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach.METHODS: All rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses.RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048).CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.

AB - BACKGROUND: Rectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach.METHODS: All rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses.RESULTS: From 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00-1.12, p = 0.048).CONCLUSIONS: In European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.

U2 - 10.1016/j.ejso.2020.02.033

DO - 10.1016/j.ejso.2020.02.033

M3 - Article

C2 - 32224070

SN - 0748-7983

VL - 46

SP - 1124

EP - 1130

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 6

ER -

Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort

Abstract

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