title: Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis.
abstract: BACKGROUND
  The objective of the present analysis was to assess whether small bowel gastrointestinal stromal tumor (GIST) is associated with worse cancer-specific survival (CSS) and overall survival (OS) compared with gastric GIST on a population-based level.
  
  
  METHODS
  Data on patients aged 18 years or older with histologically proven GIST was extracted from the SEER database from 1998 to 2011. OS and CSS for small bowel GIST were compared with OS and CSS for gastric GIST by application of adjusted and unadjusted Cox regression analyses and propensity score analyses.
  
  
  RESULTS
  GIST were located in the stomach (n = 3011, 59 %), duodenum (n = 313, 6 %), jejunum/ileum (n = 1288, 25 %), colon (n = 139, 3 %), rectum (n = 172, 3 %), and extraviscerally (n = 173, 3 %). OS and CSS of patients with GIST in the duodenum [OS, HR 0.95, 95 % confidence interval (CI) 0.76-1.19; CSS, HR 0.99, 95 % CI 0.76-1.29] and in the jejunum/ileum (OS, HR 0.97, 95 % CI 0.85-1.10; CSS, HR = 0.95, 95 % CI 0.81-1.10) were similar to those of patients with gastric GIST in multivariate analyses. Conversely, OS and CSS of patients with GIST in the colon (OS, HR 1.40; 95 % CI 1.07-1.83; CSS, HR 1.89, 95 % CI 1.41-2.54) and in an extravisceral location (OS, HR 1.42, 95 % CI 1.14-1.77; CSS, HR = 1.43, 95 % CI 1.11-1.84) were significantly worse than those of patients with gastric GIST.
  
  
  CONCLUSIONS
  Contrary to common belief, OS and CSS of patients with small bowel GIST are not statistically different from those of patients with gastric GIST when adjustment is made for confounding variables on a population-based level. The prognosis of patients with nongastric GIST is worse because of a colonic and extravisceral GIST location. These findings have implications regarding adjuvant treatment of GIST patients. Hence, the dogma that small bowel GIST patients have worse prognosis than gastric GIST patients and therefore should receive adjuvant treatment to a greater extent must be revisited.
authors.affiliation: Division of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland. ulrich.gueller@kssg.ch.|University Clinic for Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland. ulrich.gueller@kssg.ch.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.affiliation: Department of General, Abdominal and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Division of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cerny
authors.affiliation: Department of General, Abdominal and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.|Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007414:Intestinal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D057216:Propensity Score; D018426:SEER Program; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Gastrointestinal stromal tumors; Mortality; Propensity score; Small bowel neoplasms; Stomach neoplasms; Surveillance, Epidemiology, and End Results Program