Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Site-specific disparities and treatment strategies in bowel gastrointestinal stromal tumors: a population-based Surveillance, Epidemiology, and End Results analysis.
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Kahana Noam, Perets Michal, Boaz Elad, Wignakumar Anjelli, Boutros Marylise, Emile Sameh Hany
Аннотация
BACKGROUND: Gastrointestinal stromal tumors (GISTs) arising in the bowel exhibit substantial clinical and biological heterogeneity. They are commonly analyzed as a single entity, which obscures important site-specific disparities. This study aimed to evaluate demographic profiles, clinicopathological characteristics, treatment patterns, and their association with survival according to anatomical location.
METHODS: This was a retrospective population-based cohort study conducted using the Surveillance, Epidemiology, and End Results database (2000-2022). Patients were stratified by anatomical location: small intestine, colon, and rectum. The primary outcome was 5-year cancer-specific survival (CSS).
RESULTS: A total of 5760 patients with bowel GISTs were identified. Most tumors were located in the small intestine (85%), followed by the rectum (8.5%) and colon (6.6%). Patients with colonic tumors were older and had a markedly higher proportion of Black patients than those with tumors in other sites. Rectal GISTs had the highest 5-year CSS (86.5%), followed by the small intestine (81.0%), whereas colonic GISTs had the lowest 5-year CSS (67.2%). In multivariate analysis, colonic location was not an independent predictor of poor survival, whereas rectal location was independently associated with improved survival (hazard ratio, 0.31; P =.026). Surgical resection, with or without systemic therapy, was associated with markedly improved survival across most sites. Patients with rectal GISTs achieved a high 5-year CSS even with systemic therapy alone (77.7%).
CONCLUSION: Bowel GISTs are a heterogeneous group with distinct profiles based on anatomical location. Although colonic GISTs have poorer unadjusted outcomes, rectal GISTs exhibit a consistent survival advantage, likely due to earlier detection and high therapy responsiveness. Site-specific risk stratification is essential for optimizing management.
METHODS: This was a retrospective population-based cohort study conducted using the Surveillance, Epidemiology, and End Results database (2000-2022). Patients were stratified by anatomical location: small intestine, colon, and rectum. The primary outcome was 5-year cancer-specific survival (CSS).
RESULTS: A total of 5760 patients with bowel GISTs were identified. Most tumors were located in the small intestine (85%), followed by the rectum (8.5%) and colon (6.6%). Patients with colonic tumors were older and had a markedly higher proportion of Black patients than those with tumors in other sites. Rectal GISTs had the highest 5-year CSS (86.5%), followed by the small intestine (81.0%), whereas colonic GISTs had the lowest 5-year CSS (67.2%). In multivariate analysis, colonic location was not an independent predictor of poor survival, whereas rectal location was independently associated with improved survival (hazard ratio, 0.31; P =.026). Surgical resection, with or without systemic therapy, was associated with markedly improved survival across most sites. Patients with rectal GISTs achieved a high 5-year CSS even with systemic therapy alone (77.7%).
CONCLUSION: Bowel GISTs are a heterogeneous group with distinct profiles based on anatomical location. Although colonic GISTs have poorer unadjusted outcomes, rectal GISTs exhibit a consistent survival advantage, likely due to earlier detection and high therapy responsiveness. Site-specific risk stratification is essential for optimizing management.