Elderly patients with gastrointestinal stromal tumour (GIST) receive less treatment irrespective of performance score or comorbidity - A retrospective multicentre study in a large cohort of GIST patients.
Date
2017-11Author
Farag, S
van Coevorden, F
Sneekes, E
Grunhagen, DJ
Reyners, AKL
Boonstra, PA
van der Graaf, WT
Gelderblom, HJ
Steeghs, N
Type
Journal Article
Metadata
Show full item recordAbstract
Objective Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce.Methods Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression.Results Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04). Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01).Conclusions Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.
Collections
Subject
Humans
Gastrointestinal Neoplasms
Gastrointestinal Stromal Tumors
Disease Progression
Antineoplastic Agents
Disease-Free Survival
Treatment Outcome
Chemotherapy, Adjuvant
Digestive System Surgical Procedures
Registries
Multivariate Analysis
Logistic Models
Odds Ratio
Risk Factors
Chi-Square Distribution
Retrospective Studies
Age Factors
Comorbidity
Health Status
Time Factors
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Delivery of Health Care
Netherlands
Female
Male
Healthcare Disparities
Young Adult
Kaplan-Meier Estimate
Practice Patterns, Physicians'
Process Assessment, Health Care
Research team
Clinical and Translational Sarcoma
Language
eng
Date accepted
2017-09-06
License start date
2017-11
Citation
European journal of cancer (Oxford, England : 1990), 2017, 86 pp. 318 - 325