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Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis

Background: Rectal gastrointestinal stromal tumours (GISTs) have many treatment options, but uncertainty remains regarding the best treatment regimen for this rare pathology. The aim of this review is to assess the optimal management approach including timing of chemotherapy. Methods: PubMed, EMBASE...

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Autores principales: Khan, Shaheer I., O’Sullivan, Niall J., Temperley, Hugo C., Rausa, Emanuele, Mehigan, Brian J., McCormick, Paul, Larkin, John O., Kavanagh, Dara O., Kelly, Michael E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857930/
https://www.ncbi.nlm.nih.gov/pubmed/36661683
http://dx.doi.org/10.3390/curroncol30010034
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author Khan, Shaheer I.
O’Sullivan, Niall J.
Temperley, Hugo C.
Rausa, Emanuele
Mehigan, Brian J.
McCormick, Paul
Larkin, John O.
Kavanagh, Dara O.
Kelly, Michael E.
author_facet Khan, Shaheer I.
O’Sullivan, Niall J.
Temperley, Hugo C.
Rausa, Emanuele
Mehigan, Brian J.
McCormick, Paul
Larkin, John O.
Kavanagh, Dara O.
Kelly, Michael E.
author_sort Khan, Shaheer I.
collection PubMed
description Background: Rectal gastrointestinal stromal tumours (GISTs) have many treatment options, but uncertainty remains regarding the best treatment regimen for this rare pathology. The aim of this review is to assess the optimal management approach including timing of chemotherapy. Methods: PubMed, EMBASE, and Cochrane databases were searched for relevant articles comparing the impact of radical vs. local excision, and neoadjuvant vs. adjuvant therapy had on outcomes in the management of rectal GISTs. We specifically evaluated the influence that the aforementioned factors had on margins, recurrence, overall survival, 5-year disease-free survival, and hospital length of stay. Results: Twenty-eight studies met our predefined criteria and were included in our study, twelve of which were included in the quantitative synthesis. When comparing neoadjuvant versus adjuvant chemotherapy, our meta-analysis noted no significance in terms of margin negativity (R0) (odds ratio [OR] 2.01, 95% confidence interval [CI], 0.7–5.79, p = 0.20) or recurrence rates (OR 0.22, 95% CI, 0.02–1.91, p = 0.17). However, there was a difference in overall 5-year survival in favour of neoadjuvant therapy (OR 3.19, 95% CI, 1.37–7.40, * p = 0.007). Comparing local excision versus radical excision, our meta-analysis observed no significance in terms of overall 5-year survival (OR1.31, 95% CI, 0.81–2.12, p = 0.26), recurrence (OR 0.67, 95% CI, 0.40–1.13, p = 0.12), or 5-year disease-free survival (OR 1.10, 95% CI, 0.55–2.19, p = 0.80). There was a difference in length of hospital stay with a reduced mean length of stay in local excision group (mean difference [MD] 6.74 days less in the LE group; 95% CI, −6.92–−6.56, * p =< 0.00001) as well as a difference in R0 rates in favour of radical resection (OR 0.68, 95% CI, 0.47–0.99, * p = 0.05). Conclusion: Neoadjuvant chemotherapy is associated with improved overall 5-year survival, while local excision is associated with reduced mean length of hospital stay. Further large-volume, prospective studies are required to further define the optimal treatment regimen in this complex pathology.
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spelling pubmed-98579302023-01-21 Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis Khan, Shaheer I. O’Sullivan, Niall J. Temperley, Hugo C. Rausa, Emanuele Mehigan, Brian J. McCormick, Paul Larkin, John O. Kavanagh, Dara O. Kelly, Michael E. Curr Oncol Systematic Review Background: Rectal gastrointestinal stromal tumours (GISTs) have many treatment options, but uncertainty remains regarding the best treatment regimen for this rare pathology. The aim of this review is to assess the optimal management approach including timing of chemotherapy. Methods: PubMed, EMBASE, and Cochrane databases were searched for relevant articles comparing the impact of radical vs. local excision, and neoadjuvant vs. adjuvant therapy had on outcomes in the management of rectal GISTs. We specifically evaluated the influence that the aforementioned factors had on margins, recurrence, overall survival, 5-year disease-free survival, and hospital length of stay. Results: Twenty-eight studies met our predefined criteria and were included in our study, twelve of which were included in the quantitative synthesis. When comparing neoadjuvant versus adjuvant chemotherapy, our meta-analysis noted no significance in terms of margin negativity (R0) (odds ratio [OR] 2.01, 95% confidence interval [CI], 0.7–5.79, p = 0.20) or recurrence rates (OR 0.22, 95% CI, 0.02–1.91, p = 0.17). However, there was a difference in overall 5-year survival in favour of neoadjuvant therapy (OR 3.19, 95% CI, 1.37–7.40, * p = 0.007). Comparing local excision versus radical excision, our meta-analysis observed no significance in terms of overall 5-year survival (OR1.31, 95% CI, 0.81–2.12, p = 0.26), recurrence (OR 0.67, 95% CI, 0.40–1.13, p = 0.12), or 5-year disease-free survival (OR 1.10, 95% CI, 0.55–2.19, p = 0.80). There was a difference in length of hospital stay with a reduced mean length of stay in local excision group (mean difference [MD] 6.74 days less in the LE group; 95% CI, −6.92–−6.56, * p =< 0.00001) as well as a difference in R0 rates in favour of radical resection (OR 0.68, 95% CI, 0.47–0.99, * p = 0.05). Conclusion: Neoadjuvant chemotherapy is associated with improved overall 5-year survival, while local excision is associated with reduced mean length of hospital stay. Further large-volume, prospective studies are required to further define the optimal treatment regimen in this complex pathology. MDPI 2022-12-28 /pmc/articles/PMC9857930/ /pubmed/36661683 http://dx.doi.org/10.3390/curroncol30010034 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Khan, Shaheer I.
O’Sullivan, Niall J.
Temperley, Hugo C.
Rausa, Emanuele
Mehigan, Brian J.
McCormick, Paul
Larkin, John O.
Kavanagh, Dara O.
Kelly, Michael E.
Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title_full Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title_fullStr Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title_full_unstemmed Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title_short Gastrointestinal Stromal Tumours (GIST) of the Rectum: A Systematic Review and Meta-Analysis
title_sort gastrointestinal stromal tumours (gist) of the rectum: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857930/
https://www.ncbi.nlm.nih.gov/pubmed/36661683
http://dx.doi.org/10.3390/curroncol30010034
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