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Preoperative Chemotherapy and Survival for Large Anorectal Gastrointestinal Stromal Tumors: A National Analysis of 333 Cases

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Anorectal gastrointestinal stromal tumors (GISTs) are exceedingly rare, and management remains controversial in regard to local resection (LR) and preoperative chemotherapy.

Methods

The National Cancer Data Base was queried from 1998 to 2012 for cases of GIST resection in the rectum or anus. Patient demographics, type of surgery (LR vs. radical excision [RE]), short-term outcomes, and overall survival (OS) were analyzed. Preoperative chemotherapy was recorded following the US FDA approval of imatinib in 2002.

Results

Overall, 333 patients with resection of anorectal GISTs were included. Mean age at presentation was 62.3 years (range 22–90), and median tumor size was 4.0 cm (interquartile range 2.2–7.0). Five-year OS for all patients was 77.6%. In a multivariable survival analysis, only age and tumor size >5 cm (hazard ratio 2.48, 95% confidence interval 1.50–4.01; p = 0.004) were associated with increased mortality. One hundred and sixty-three (49.0%) patients underwent LR, compared with 158 (47.4%) who underwent RE. For tumors smaller than 5 cm, no difference in 5-year survival by surgical approach was observed (LR 82.3% vs. RE 82.6%; p = 0.71). Fifty-nine patients (17.7%) received preoperative chemotherapy; for patients undergoing RE with tumors >5 cm, there was decreased mortality in the group who received preoperative chemotherapy (5-year OS with chemotherapy 79.2% vs. no chemotherapy 51.2%; p = 0.03).

Conclusions

Size is the most important determinant in survival following resection. Local excision is common, with resection split between LR and RE. For smaller tumors, LR may be adequate therapy. Preoperative chemotherapy may result in improved survival for large tumors treated with radical resection, but the data are imperfect.

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Acknowledgements

The authors wish to thank Drs. Elisa Birnbaum and Sekhar Dharmarajan for their help with this article. Dr. Alex B. Haynes’ introduction to the NCDB was greatly appreciated.

Funding

This study was supported by departmental funding.

Disclosures

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.

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Authors and Affiliations

  1. Division of General Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, St Louis, MO, USA

    Alexander T. Hawkins MD, MPH, Katerina O. Wells MD, MPH, Devi Mukkai Krishnamurty MD, Steven R. Hunt MD, Matthew G. Mutch MD, Sean C. Glasgow MD, Paul E. Wise MD & Matthew L. Silviera MD

Authors
  1. Alexander T. Hawkins MD, MPH
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  2. Katerina O. Wells MD, MPH
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  3. Devi Mukkai Krishnamurty MD
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  4. Steven R. Hunt MD
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  5. Matthew G. Mutch MD
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  6. Sean C. Glasgow MD
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  7. Paul E. Wise MD
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  8. Matthew L. Silviera MD
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Corresponding author

Correspondence to Matthew L. Silviera MD.

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Hawkins, A.T., Wells, K.O., Krishnamurty, D.M. et al. Preoperative Chemotherapy and Survival for Large Anorectal Gastrointestinal Stromal Tumors: A National Analysis of 333 Cases. Ann Surg Oncol 24, 1195–1201 (2017). https://doi.org/10.1245/s10434-016-5706-1

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  • DOI: https://doi.org/10.1245/s10434-016-5706-1

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