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Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Approximately 5% of gastrointestinal stromal tumors (GISTs) originate in the rectum, and historically, radical resection was commonly performed. Little is known about the outcome for rectal GIST in the era of imatinib.

Methods

Using a prospectively maintained database, this study retrospectively analyzed 47 localized primary rectal GISTs treated at our center from 1982 to 2016, stratified by when imatinib became available in 2000. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were analyzed by the Kaplan–Meier method.

Results

Rectal GISTs represented 7.1% of 663 primary GISTs. The findings showed 17 patients in the pre-imatinib era and 30 patients in the imatinib era. The two groups had similar follow-up evaluation, age, gender, Miettinen risk, and distance to the anal verge. In the imatinib era, tumors were smaller at diagnosis (median 4 vs. 5 cm; p = 0.029), and 24 of the 30 patients received perioperative imatinib. In the high-risk patients, organ preservation and negative margins were more common among the 13 patients treated with neoadjuvant imatinib than among the 21 patients treated directly with surgery. High-risk patients who received perioperative imatinib (n = 15) had greater (or nearly significantly greater) 5-year OS, DSS, local RFS, and distant RFS than those who did not (n = 19) (91, 100, 100, and 71% vs. 47, 65, 74, and 41%; p = 0.049, 0.052, 0.077, 0.051, respectively). In the imatinib era, no patient has had a local recurrence or death due to GIST.

Conclusions

The use of imatinib is associated with organ preservation and improved oncologic outcome for patients with rectal GIST.

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Acknowledgment

We thank Heidi Trenholm and Christina Curtin from the Memorial Sloan Kettering Cancer Center sarcoma database for their efforts extracting data.

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Author notes

  1. Michael J. Cavnar and Lin Wang have contributed equally.

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Michael J. Cavnar MD, Vinod P. Balachandran MD, Sam Singer MD, Larissa Temple MD, Garrett M. Nash MD, Martin R. Weiser MD, Jose G. Guillem MD, Julio Garcia Aguilar MD, Ronald P. DeMatteo MD & Philip B. Paty MD

  2. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Michael J. Cavnar MD

  3. Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China

    Lin Wang MD

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Cristina R. Antonescu MD

  5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    William D. Tap MD & Mary Keohan MD

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  1. Michael J. Cavnar MD
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Correspondence to Philip B. Paty MD.

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Cavnar, M.J., Wang, L., Balachandran, V.P. et al. Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome. Ann Surg Oncol 24, 3972–3980 (2017). https://doi.org/10.1245/s10434-017-6087-9

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