Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis

doi:10.3748/wjg.v27.i36.6128

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Sep 28, 2021; 27(36): 6128-6141
Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6128

Table 1 Preoperative clinical characteristics of solitary gastrointestinal stromal tumors and multiple gastrointestinal stromal tumors in the entire cohort and after propensity score matching

Parameters	Entire cohort, before matching		P value	Propensity score matched cohort		P value
Parameters	SGIST, n (%)	MGIST, n (%)	P value	SGIST, n (%)	MGIST, n (%)	P value
All cases	942	41		164	41
Age (yr)			0.450			0.889
≤ 60	516 (54.78)	20 (48.78)		82 (50.00)	20 (48.78)
> 60	426 (45.22)	21 (51.22)		82 (50.00)	21 (51.22)
Gender			0.060			0.596
Male	479 (50.85)	27 (65.85)		115 (70.12)	27 (65.85)
Female	463 (49.15)	14 (34.15)		49 (29.88)	14 (34.15)
BMI (kg/m²)			0.010			0.193
BMI < 18.5	41 (4.35)	6 (14.63)		11 (6.71)	6 (14.63)
18.5 ≤ BMI < 25	501 (53.18)	19 (46.34)		94 (57.32)	19 (46.34)
BMI ≥ 25	400 (42.46)	16 (39.02)		59 (35.98)	16 (39.02)
Tobacco use			0.899			0.093
No	704 (74.73)	31 (75.61)		101 (61.59)	31 (75.61)
Yes	238 (25.27)	10 (24.39)		63 (38.41)	10 (24.39)
Alcohol use			0.514			0.768
No	687 (72.93)	28 (60.98)		108 (65.85)	28 (60.98)
Yes	255 (27.07)	13 (31.71)		56 (34.15)	13 (31.71)
ASA score			0.443			0.868
I/II	779 (82.70)	32 (78.05)		126 (74.83)	32 (78.05)
III/IV	163 (17.30)	9 (21.95)		38 (23.17)	9 (21.85)
Comorbidities¹			0.236			1.000
Present	417 (44.27)	22 (53.66)		88 (53.66)	22 (53.66)
Absent	525 (55.73)	19 (46.34)		76 (46.34)	19 (46.34)
Location			0.450			0.884
Gastric	650 (69.00)	26 (63.41)		106 (64.63)	26 (63.41)
Non-gastric	292 (31.00)	15 (36.58)		58 (35.37)	15 (36.58)
Chief complaint
Abdominal pain	303 (32.17)	15 (36.58)	0.554	54 (32.93)	15 (36.58)	0.657
Abdominal distention	149 (15.82)	9 (21.95)	0.295	23 (14.02)	9 (21.95)	0.211
Hematemesis	42 (4.46)	3 (7.32)	0.429	9 (5.49)	3 (7.32)	0.710
Hematochezia	167 (17.72)	9 (21.95)	0.490	34 (20.73)	9 (21.95)	0.864
Medical examination	275 (29.19)	11 (26.83)	0.744	42 (25.61)	11 (26.83)	0.906
Other	96 (10.19)	2 (4.88)	0.266	17 (10.37)	2 (4.88)	0.278

¹Comorbidities: comprised of hypertension, diabetes mellitus, anemia, pulmonary disease (asthma, pneumonia, chronic obstructive pulmonary disease, etc.), heart disease (arrhythmia, coronary atherosclerotic heart disease, etc.), liver disease (hepatitis, cirrhosis, etc.), renal disease (nephritis, chronic kidney disease, etc.) and central nervous system disease (cerebrovascular disease, neurodegenerative disease, etc.). Bold values indicate P < 0.05. ASA: American Society of Anesthesiologists; BMI: Body mass index; MGIST: Multiple gastrointestinal stromal tumors; SGIST: Solitary gastrointestinal stromal tumors.

Table 2 Surgical and postoperative pathological characteristics and treatment of the solitary gastrointestinal stromal tumors and multiple gastrointestinal stromal tumors of the entire cohort and after propensity score matching

Parameters	Entire cohort, before matching		P value	Propensity score matched cohort		P value
Parameters	SGIST, n (%)	MGIST, n (%)	P value	SGIST, n (%)	MGIST, n (%)	P value
All cases	942	41		164	41
Surgical approach			0.028			0.361
Open	458 (48.62)	27 (65.85)		94 (57.32)	27 (65.85)
Laparoscopic	255 (27.07)	11 (26.83)		43 (26.22)	11 (26.83)
Endoscopic	229 (24.31)	3 (7.32)		27 (14.63)	3 (7.32)
Blood transfusion			0.161			1.000
Yes	171 (18.15)	11 (26.83)		44 (26.83)	11 (26.83)
No	771 (81.85)	30 (73.17)		120 (73.17)	30 (73.17)
Tumor size (cm)			0.007			0.200
Length ≤ 5	575 (61.04)	15 (36.59)		74 (45.12)	15 (36.59)
5 < Length ≤ 10	239 (25.37)	16 (39.02)		41 (25.00)	16 (39.02)
Length > 10	128 (13.59)	10 (24.39)		49 (29.88)	10 (24.39)
Mitotic index (per 50 HPF)			0.009			0.715
0-5	724 (76.86)	27 (65.85)		101 (61.59)	27 (65.85)
6-10	127 (13.48)	4 (9.76)		24 (14.63)	4 (9.76)
> 10	91 (9.66)	10 (24.39)		39 (23.78)	10 (24.39)
Modified NIH risk			0.044			0.486
Very low	210 (22.29)	4 (9.76)		29 (17.68)	4 (9.76)
Low	291 (30.89)	9 (21.95)		30 (18.29)	9 (21.95)
Intermediate	147 (15.61)	8 (19.51)		22 (13.41)	8 (19.51)
High	294 (31.21)	20 (48.78)		83 (50.61)	20 (48.78)
Operate time (min)			0.336			0.627
mean ± SD	139 ± 78	151 ± 63		145 ± 67	151 ± 63
Median (IQR)	120 (80-180)	150 (120-180)		140 (90-190)	150 (120-180)
Intraoperative tumor rupture			0.376			0.490
Yes	10 (1.06)	1 (2.44)		2 (1.22)	1 (2.44)
No	932 (98.94)	40 (97.56)		162 (98.78)	40 (97.56)
Hospitalization time in d			0.226			0.442
mean ± SD	13.55 ± 6.32	14.78 ± 7.66		13.96 ± 5.69	14.78 ± 7.66
Median (IQR)	12 (10-15)	14 (9-16)		13 (11-16)	14 (9-16)
Postoperative complications			0.391			0.610
Present	179 (19.00)	10 (24.39)		34 (20.73)	10 (24.39)
Absent	763 (81.00)	31 (73.61)		130 (79.27)	31 (73.61)
Imatinib treatment			0.187			0.832
Yes	298 (31.63)	17 (41.46)		71 (43.29)	17 (41.46)
No	644 (68.37)	24 (58.54)		93 (56.71)	24 (58.54)

Bold values indicate P < 0.05. HPF: High power field; IQR: Interquartile range; MGIST: Multiple gastrointestinal stromal tumors; NIH: National Institutes of Health; SD: SD; SGIST: Solitary gastrointestinal stromal tumors.

Table 3 Univariate and multivariate of the clinicopathological factors for progression-free survival

Characteristics	Univariate analysis		Multivariate analysis
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value
Age in yr
≤ 60	Reference		Reference
> 60	1.845 (0.953-3.571)	0.069	1.525 (0.740-3.143)	0.252
Sex
Female	Reference
Male	0.913 (0.460-1.809)	0.793
Comorbidities
Absent	Reference
Present	1.147 (0.606-2.172)	0.673
Tumor location
Gastric	Reference		Reference
Non-gastric	3.548 (1.847-6.818)	< 0.001	3.176 (1.526-6.607)	0.002
Tumor size in cm		0.001		0.035
Length ≤ 5	Reference		Reference
5 < Length ≤ 10	3.022 (1.117-8.179)	0.029	2.180 (0.716-6.642)	0.170
Length > 10	5.848 (2.359-14.499)	< 0.001	4.071 (1.375-12.052)	0.011
Mitotic index, per 50 HPF		< 0.001		0.001
0-5	Reference		Reference
6-10	4.094 (1.555-10.777)	0.004	4.108 (1.309-12.897)	0.015
> 10	7.859 (3.676-16.799)	< 0.001	6.577 (2.540-17.029)	< 0.001
Surgical approach		0.251
Open	Reference
Laparoscopic	0.449 (0.174-1.154)	0.096
Endoscopic	0 (0-1.006E+230)	0.961
Blood transfusion
No	Reference		Reference
Yes	2.176 (1.143-4.145)	0.018	1.569 (0.739-3.332)	0.241
Intraoperative tumor rupture
No	Reference		Reference
Yes	6.383 (1.524-26.726)	0.011	4.458 (0.863-23.015)	0.074
Imatinib treatment
Yes	Reference		Reference
No	0.584 (0.290-1.178)	0.133	4.608 (2.030-10.461)	< 0.001
MGIST
Absent	Reference		Reference
Present	2.091 (1.055-4.145)	0.035	2.431 (1.097-5.386)	0.029

Bold values indicate P < 0.05. CI: Confidence interval; HPF: High power field; HR: Hazard ratio; MGIST: Multiple gastrointestinal stromal tumors.

Table 4 Univariate and multivariate analysis of the clinicopathological factors for overall survival

Characteristics	Univariate analysis		Multivariate analysis
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value
Age in yr
≤ 65	Reference
> 65	1.665 (0.754-3.676)	0.207
Gender
Female	Reference
Male	1.099 (0.461-2.616)	0.832
Comorbidities
Absent	Reference
Present	1.061 (0.491-2.291)	0.881
Tumor location
Gastric	Reference		Reference
Non-gastric	4.428 (1.967-9.965)	< 0.001	3.812 (1.577-9.213)	0.003
Tumor size in cm		0.021		0.556
Length ≤ 5	Reference		Reference
5 < Length ≤ 10	2.279 (0.722-7.189)	0.160	1.381 (0.346-5.519)	0.648
Length > 10	4.159 (1.498-11.549)	0.006	2.070 (0.539-7.959)	0.290
Mitotic index, per 50 HPF		< 0.001		0.015
0-5	Reference		Reference
6-10	3.120 (0.913-10.669)	0.070	4.129 (0.963-17.707)	0.056
> 10	7.515 (3.045-18.548)	< 0.001	6.051 (1.762-20.778)	0.004
Surgical approach		0.684
Open	Reference
Laparoscopic	0.621 (0.213-1.815)	0.384
Endoscopic	0 (0-3.609E+275)	0.968
Blood transfusion
No	Reference		Reference
Yes	2.832 (1.312-6.113)	0.008	1.298 (0.547-3.082)	0.554
Intraoperative tumor rupture
No	Reference		Reference
Yes	5.094 (0.682-38.043)	0.113	3.264 (0.355-30.022)	0.296
Imatinib treatment
Yes	Reference		Reference
No	2.952 (1.113-7.831)	0.030	7.841 (2.677-22.693)	< 0.001
MGIST
Absent	Reference		Reference
Present	2.050 (0.889-4.726)	0.092	2.404 (0.830-6.966)	0.106

Bold values indicate P < 0.05. CI: Confidence interval; HPF: High power field; HR: Hazard ratio; MGIST: Multiple gastrointestinal stromal tumors.

Citation: Wu H, Li C, Li H, Shang L, Jing HY, Liu J, Fang Z, Du FY, Liu Y, Fu MD, Jiang KW, Li LP. Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis. World J Gastroenterol 2021; 27(36): 6128-6141
URL: https://www.wjgnet.com/1007-9327/full/v27/i36/6128.htm
DOI: https://dx.doi.org/10.3748/wjg.v27.i36.6128