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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2022

05-10-2022 | Metastasis | Sarcoma

Lymph Node Metastases in Gastrointestinal Stromal Tumors: an Uncommon Event

Authors: Zachary E. Stiles, DO, MS, Andrew M. Fleming, MD, Paxton V. Dickson, MD, Miriam Tsao, MD, Evan S. Glazer, MD, PhD, David Shibata, MD, Jeremiah L. Deneve, DO

Published in: Annals of Surgical Oncology | Issue 13/2022

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Abstract

Background

Lymph node (LN) metastases are uncommon among gastrointestinal stromal tumors (GISTs), and their presence has not been utilized in disease prognostication. This study was designed to examine factors associated with GIST nodal metastases and their impact on survival.

Patients and Methods

Patients undergoing surgical resection of GIST with nodal evaluation were selected from the National Cancer Database. Logistic regression was utilized to evaluate factors associated with LN metastases. Survival was assessed for patients with and without nodal involvement and Cox regression was used to evaluate the impact of LN metastases while adjusting for other prognostic factors.

Results

Out of 5018 patients, 301 (6.0%) had LN involvement. Nodal metastases occurred most frequently among tumors of the stomach (49.5%), followed by the small bowel (43.2%), colorectum (6.0%), and esophagus (1.3%). On multivariable analysis, male sex (OR 1.34), high mitotic rate (OR 2.10), tumor size (OR 1.02), and a primary tumor located in the small bowel (OR 1.36) were all significantly associated with nodal metastases. LN metastases were significantly associated with decreased overall survival (OS) for tumors arising in the small bowel (log-rank p < 0.01) and the colorectum (log-rank p < 0.01). Within a multivariable model adjusting for established prognostic factors, LN metastases remained independently associated with decreased survival (HR 1.60, p < 0.001).

Conclusions

For GISTs, LN metastases occur more often in males and were associated with tumor size and mitotic activity. Nodal involvement is associated with decreased survival, independent of other well-established prognostic factors.
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Metadata
Title
Lymph Node Metastases in Gastrointestinal Stromal Tumors: an Uncommon Event
Authors
Zachary E. Stiles, DO, MS
Andrew M. Fleming, MD
Paxton V. Dickson, MD
Miriam Tsao, MD
Evan S. Glazer, MD, PhD
David Shibata, MD
Jeremiah L. Deneve, DO
Publication date
05-10-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12582-1

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