Long-term Outcomes of Endoscopic Therapy vs Surgical Resection for Gastrointestinal Stromal Tumors

Study findings reveal no significant difference in long-term survival among patients with gastrointestinal stromal tumors (GISTs) receiving endoscopic therapy vs surgical resection.

“With the rapid development of endoscopic technology, endoscopic therapy has gradually become a new treatment choice for GISTs,” wrote Haihao Yan, MD, Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China, and coauthors.

“However, due to the low incidence of duodenal GIST and the difficulty of [endoscopic therapy], there is a lack of data to compare the long-term results of [endoscopic therapy] and surgical resection,” they continued.

Patients diagnosed with duodenal GIST between 2004 and 2015 were selected from the surveillance, epidemiology, and end results (SEER) database for this analysis. Kaplan-Meier methodology and long-rank test were used to examine differences in 5- and 10-year survival between patients who receive endoscopic therapy vs surgery. Cox proportional hazard model was used to analyze risk factors influencing prognosis.

Dr Yan and colleagues performed 1:1 propensity-score matching to reduce confounding factors and then re-compared survival differences between the 2 groups.

A total of 294 patients were enrolled, including 44 (13.9%) patients who received endoscopic therapy and 253 (86.1%) patients who received surgical resection. Prior to propensity-score matching, long-term survival was similar between the 2 groups. The 5-year overall survival (OS) was 79.7% with endoscopic therapy vs 79.3% with surgery (P = .876); 10-year OS was 66.5% vs 68.1%, respectively (P = .876).

Findings from Cox analysis revealed similar OS and cancer-specific survival between the two groups. In addition, after propensity-score matching, there were no significant difference in long-term OS and cancer-specific survival between endoscopic therapy and surgery.

“Our study found no significant difference in long-term survival between [endoscopic therapy] and surgical resection in patients with duodenal GIST. However, to obtain high-quality evidence, more extensive sample size studies are needed in the future to evaluate the long-term effects of [endoscopic therapy] on patients,” Dr Yan and colleagues concluded.

Source:
Yan H, Liu X, Yin L, et al. Effects of endoscopic therapy and surgical resection on long-term survival outcomes in patients with duodenal gastrointestinal stromal tumors: a surveillance, epidemiology, and end result program analysis. Surg Endosc. 2022 Apr 18. doi:10.1007/s00464-022-09231-9.