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The prognosis of patients with gastrointestinal stromal tumors is significantly impacted by gastrointestinal bleeding.
Patients with gastrointestinal stromal tumors are significantly impacted by GI bleeding. | Crytal Light - stockadobe.com
The prognosis of patients with gastrointestinal stromal tumors (GISTs) is significantly impacted by gastrointestinal (GI) bleeding, according to research from a systematic review and meta-analysis published in The American Surgeon.
Hazard ratio (HR): a statistical measure that compares the rate at which an occurs in one group versus another over a period of time.
Overall survival (OS): the length of time a patient lives after being diagnosed with a disease, usually measured from the start of treatment.
Recurrence-free survival (RFS): the length of time after primary cancer treatment that a patient lives without any signs of cancer recurrence or until their death.
The meta-analysis evaluated 12 studies which included 3,475 patients in total, demonstrating that bleeding significantly impacted recurrence-free survival (RFS), with a hazard ratio of 1.57, as well as overall survival (OS), with an HR of 3.04. This suggests that patients who experience GI bleeding may have a poorer prognosis compared to those who do not.
Further analysis examined the effect of bleeding location on prognosis. For patients with bleeding originating in the small intestine, there was no statistically significant difference in OS; however, those with gastric bleeding had a significantly worse prognosis than non-bleeding patients, with an HR of 4.37. Additionally, a comparison of bleeding risk between the stomach and small intestine showed that bleeding was less common in the small intestine, with an HR of 0.63.
“GI bleeding significantly impacts the prognosis of GIST patients, particularly in those with gastric bleeding,” Dr. Shuchen Bai, first author of the study, wrote in the journal article.
“The results showed that GI bleeding significantly affects the prognosis of GIST patients, including OS and RFS. Further analysis indicated that patients with gastric GIST bleeding had significantly worse prognoses, while the bleeding risk in the small intestine was lower,” Bai continued.
GISTs are common mesenchymal tumors that can arise throughout the digestive tract, with approximately 70% of patients presenting with symptoms such as abdominal pain, distension, GI bleeding or obstruction. Patients with ruptured tumors are classified as high-risk; although GI bleeding is not officially recognized as a form of tumor rupture, some studies suggest it may indicate aggressive tumor behavior, high mitotic index and poor prognosis, whereas others say that it facilitates early detection and improves outcomes. Given the conflicting data and limitations of existing research, investigators conducted a systematic review and meta-analysis to assess the impact of GI bleeding on GIST prognosis.
Utilizing databases for relevant studies published up until Dec. 31, 2023, investigators searched for terms like GIST, stromal tumor, GIST neoplasms, GIST sarcoma and others. The language of publications included were restricted to English and the meta-analysis collected data from previously published studies. Following these guidelines, two investigators extracted data, including RFS and OS, from eligible studies.
This search yielded 3,758 studies across four databases, which was then minimized to just 12 studies after deleting duplicates, reviewing the titles and abstracts and papers with insufficient data. In total, 3,475 patients were enrolled across all studies, of which, all were single-center studies; two were from South Korea and ten were from China.
Both RFS and OS served as the major survival outcome for the available studies in this meta-analysis.
In the meta-analysis, age was also a factor that was investigated as a potential factor influencing bleeding risk. Following the exclusion of a study that introduced heterogeneity, the results indicated that older age might be a protective factor against bleeding, with an HR equaling 0.81.
Several additional factors were identified as being associated with an increased risk of bleeding in GISTs including larger tumor size (HR = 1.29), male gender (HR = 1.35) and a higher mitotic index (HR = 1.24). However, tumor rupture status was not found to be statistically significant.
In regard to future research, Bai concluded by saying that, “Future research should focus on larger, multicenter studies, improve methodologies, and standardize outcome reporting to enhance the reliability of meta-analyses. Additionally, further investigation into the protective mechanisms of age on bleeding risk and the role of other potential prognostic factors in GISTs is warranted.”
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Reference:
“Impact of gastrointestinal bleeding on prognosis and associated risk factors in gastrointestinal stromal tumors: a systematic review and meta-analysis” by Dr. Shuchen Bai, et al., The American Surgeon.
