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Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort
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 ¼ 46), low anterior resection (LAR, n ¼ 31) and abdomino-perineal resection (APR,
n ¼ 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib...Show moreBackground: 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 ¼ 46), low anterior resection (LAR, n ¼ 31) and abdomino-perineal resection (APR,
n ¼ 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 1.00e1.12, p ¼ 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.
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- All authors
- IJzerman, N.S.; Mohammadi, M.; Tzanis, D.; Gelderblom, H.; Fiore, M.; Fumagalli, E.; Rutkowski, P.; Bylina, E.; Zavrakidis, I.; Steeghs, N.; Bonenkamp, H.J.; Etten, B. van; Grunhagen, D.J.; Rasheed, S.; Tekkis, P.; Honore, C.; Houdt, W. van; Hage, J. van der; Bonvalot, S.; Schrage, Y.; Smith, M.
- Date
- 2020-06-01
- Volume
- 46
- Issue
- 6
- Pages
- 1124 - 1130