Prognostic Value of Bleeding in Gastrointestinal Stromal Tumors: A Meta-Analysis

Background: Gastrointestinal bleeding is the most common clinical manifestation of gastrointestinal stromal tumor. It is of great significance to the prognosis of patients. But the results are controversial. The purpose of this study was to evaluate the relationship between gastrointestinal bleeding and clinical prognosis in patients with GIST. Methods: A systematic literature search was performed in Pumbed, Cochrane Library, EMBASE, ClinicalTrials.gov , CNKI, VIP and wanfang databases with the pattern of unlimited languages. 12 studies with 2781 individuals were included in the final analysis. The overall survival (OS), recurrence-free survival/disease-free survival (RFS/DFS) and related factors affecting bleeding in patients with gastrointestinal stromal tumor (GIST) were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were used for in the meta-analysis. Results: A total of 12 articles were included in the study, including 2781 patients with GIST, including 845 patients with gastrointestinal bleeding. The OS of GIST patients with gastrointestinal bleeding was significantly worse (HR = 2.54, 95% CI = 1.13-5.73, P = 0.025). But there was no significant difference in RFS between gastrointestinal bleeding patients and non-bleeding patients (HR = 1.35, 95% CI = 0.70-2.61, P = 0.371). Further analysis of the related factors of GI bleeding in GIST patients was observed, besides the aging factor (HR = 1.02, 95% CI = 0.69-1.50, P = 0.929), Small intestinal stromal tumor (HR = 0.56, 95% CI = 0.41-0.76, P < 0.001), tumor diameter ≥ 5 cm (HR = 2.09, 95% CI = 1.20-3.63, P = 0.009), Mitotic index ≥ 5/50 HPF (HR = 1.66, 95% CI = 1.11-2.49, P = 0.014) and tumor rupture (HR = 2.04, 95% CI = 1.0-3.82, P = 0.026) all increased the risk of GI bleeding in patients with GIST. Conclusions: The OS of GIST patients with GI bleeding was worse than non-GI bleeding, but had no significant effect on RFS. Nevertheless the aging factor, the location of GIST in the small intestine, tumor diameter ≥ 5 cm, Mitotic index ≥ 5/50 HPF and tumor rupture all increased the risk of GI bleeding in patients with GIST.

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Meta-analysis for the Association between Overall Survival and Progression-Free Survival in Gastrointestinal Stromal Tumor

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-14-1779 ◽

2014 ◽

Vol 21 (2) ◽

pp. 295-302 ◽

Cited By ~ 10

Author(s):

Ipek Özer-Stillman ◽

Lauren Strand ◽

Jane Chang ◽

Ateesha F. Mohamed ◽

Katherine E. Tranbarger-Freier

Keyword(s):

Overall Survival ◽

Gastrointestinal Stromal Tumor ◽

Meta Analysis ◽

Progression Free Survival ◽

Stromal Tumor ◽

Free Survival

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Integrating Anatomical, Molecular and Clinical Risk Factors in Gastrointestinal Stromal Tumor of the Stomach

Annals of Surgical Oncology ◽

10.1245/s10434-021-09605-8 ◽

2021 ◽

Cited By ~ 2

Author(s):

Toto Hølmebakk ◽

Anne Marit Wiedswang ◽

Leonardo A. Meza-Zepeda ◽

Ivar Hompland ◽

Ingvild V. K. Lobmaier ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Stromal Tumor ◽

Neoadjuvant Treatment ◽

Population Based ◽

Stromal Tumor ◽

Gastric Gist ◽

Tumor Rupture ◽

Free Survival ◽

Risk Patients ◽

Upper Third

Abstract Background Adjuvant imatinib for 3 years is recommended to patients with high-risk gastrointestinal stromal tumor (GIST). Risk stratification is inaccurate, and risk assessments are further complicated by the increased use of neoadjuvant treatment. Anatomical criteria for prognostication have not been investigated. Methods Clinical, molecular, and anatomical variables were retrospectively studied in a population-based cohort of 295 patients with gastric GIST resected between 2000 and 2018. Gastric subsite was divided into the upper, middle, and lower thirds. Growth pattern was classified as luminal, exophytic, or transmural based on imaging and surgical reports. Results Of 113 tumors in the upper third of the stomach, 103 (91.2%) were KIT mutated, 7 (6.2%) were PDGFRA mutated, and 104 (92.0%) harbored genotypes sensitive to imatinib. Transmural tumors were strongly associated with a high mitotic index. Five-year recurrence-free survival (RFS) was 71% for patients with transmural tumors versus 96% with luminal or exophytic tumors (hazard ratio [HR] 8.45, 95% confidence interval [CI] 3.69–19.36; p < 0.001), and, in high-risk patients, 5-year RFS was 46% for patients with transmural tumors versus 83% with luminal or exophytic tumors (HR 4.47, 95% CI 1.71–11.66; p = 0.001). Among 134 patients with tumors > 5 cm, there were 29 recurrences. Only five patients with exophytic or luminal tumors had recurrent disease, of whom four had tumor rupture. Five-year RFS for patients with exophytic/luminal tumors >5 cm without rupture was 98%. Conclusions In the upper third, over 90% of tumors were sensitive to imatinib. Patients with exophytic or luminal tumors without rupture, irrespective of size, had an excellent prognosis and may not benefit from adjuvant therapy.

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Does Gastrointestinal Bleeding Affect the Prognosis of Patients With Gastrointestinal Stromal Tumor: A Meta-analysis.

10.21203/rs.3.rs-634354/v1 ◽

2021 ◽

Author(s):

Yue Zhang ◽

Qi Liu ◽

Hao Xu

Keyword(s):

Overall Survival ◽

Gastrointestinal Bleeding ◽

Gastrointestinal Stromal Tumor ◽

Random Effects ◽

Gastrointestinal Stromal Tumors ◽

Meta Analysis ◽

Random Effects Model ◽

Relapse Free Survival ◽

Free Survival ◽

Stromal Tumors

Abstract Background: The effect of gastrointestinal bleeding on the prognosis of gastrointestinal stromal tumors has been widely studied in recent years, but it is still controversial. Therefore, we performed the first comprehensive meta-analysis to evaluate the effect of gastrointestinal bleeding on the prognosis of gastrointestinal stromal tumors.Methods: We searched PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane Library databases to recruit studies on the effect of gastrointestinal bleeding on the prognosis of patients with gastrointestinal stromal tumor. Eight studies containing 2915 patients were involved in this meta-analysis until May 31, 2021. Pooled hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated to estimate the effect using random-effects model. Results: The pooled results revealed that gastrointestinal bleeding was not associated with relapse-free survival (HR = 1.33, 95% CI 0.66-2.68, P < 0.001; random-effects model I2=87.7, P < 0.001) and overall survival (HR = 1.29, 95% CI 0.43-3.87, P < 0.001; random-effects model I2=88.9, P < 0.001) in patients with gastrointestinal stromal tumors. Conclusions: Our present a meta-analysis indicates that gastrointestinal bleeding has no effect on relapse-free survival and overall survival of patients with gastrointestinal stromal tumors, although gastrointestinal bleeding is one of the major clinical symptoms of gastrointestinal stromal tumors.

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