Based on a descriptive, U.S. population–based cohort study reported in JAMA Network Open by Alvarez et al, over the past 2 decades, the incidence of gastrointestinal stromal tumors in major organ sites has increased among several patient populations. The findings may assist in directing future research to reduce the burden of survival disparities in minoritized groups.
“Age-adjusted incidence rates for common digestive gastrointestinal stromal tumors increased between 2% and 7% from 2000 to 2019, mostly for early-stage tumors,” the investigators commented. “Survival disparities among racial and ethnic groups were found for some organ sites.”
Study Details
Using nationally representative data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, including the SEER-22 (n = 23,001; mean age = 64; males: 51.3%) and SEER-17 (n = 12,109; mean age = 64; males: 51.9%) registries, the investigators identified patients older than 20 with gastrointestinal stromal tumors diagnosed between January 2000 and December 2019. Of these database cohorts, 9.7% and 13.3% were Asian/Pacific Islander, 12.3% and 11.6% were Hispanic, 19.6% and 17.8% were non-Hispanic Black, and 57.7% and 56.6% were non-Hispanic White, respectively.
Organ site–specific trends in age-standardized incidence rates and annual percentage changes were calculated by race and ethnicity and, when possible, by sex, age, and primary indicator. The investigators used multivariable Cox proportional hazards regression models to examine racial and ethnic differences in overall and gastrointestinal stromal tumor–specific survival by site. Statistical significance was defined as two-tailed P < .05, with a 95% confidence interval.
Epidemiology of Gastrointestinal Stromal Tumors
In the SEER-22 cohort, the overall incidence rates of gastrointestinal stromal tumors were found to substantially increase over time for all organ sites but the colon (annual percent change: esophagus, 7.3%, 95% confidence interval [CI] = 4.4%–10.2%; gastric, 5.1%, 95% CI = 4.2%–6.1%; small intestine, 2.7%, 95% CI = 1.8%–3.7%; colon, −0.2%, 95% CI = −1.3% to 0.9%; and rectum, 1.9%, 95% CI = 0.1%–3.8%). The investigators reported similar increasing trends by age groups (< 50 vs ≥ 50 years), sex, race and ethnicity, and primary indicator for gastric and small intestine gastrointestinal stromal tumors. Increases appeared to be largely limited to localized-stage disease.
Non-Hispanic Black vs White patients in the SEER-17 cohort seemed to have higher overall mortality from esophageal (adjusted hazard ratio [HR] = 6.4, 95% CI = 2.0–20.3) and gastric (adjusted HR = 1.4, 95% CI = 1.2–1.5]) gastrointestinal stromal tumors. Asian/Pacific Islander patients with esophageal gastrointestinal stromal tumors were also found to experience such an adverse outcome (adjusted HR = 5.6, 95% CI = 1.5–20.2). According to the investigators, the results were similar for gastrointestinal stromal tumor–specific survival.
“These findings suggest that additional studies are warranted to identify risk factors, as histologic reclassification and higher availability of endoscopy and imaging do not fully explain these unfavorable incidence trends,” the investigators concluded. “Prevention efforts are needed to reduce the substantial survival disparities among racial and ethnic minoritized populations.”
Constanza Camargo, PhD, of the National Cancer Institute, Rockville, Maryland, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was funded by the National Institutes of Health Intramural Research Program of the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
