Disappearance of Racial Disparities in Gastrointestinal Stromal Tumor Outcomes

Michael C. Cheung, Ying Zhuge, Relin Yang, Leonidas G. Koniaris

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine the effects of race, socioeconomic status, and demographic and clinical variables on the outcomes of gastrointestinal stromal tumors (GISTs). Study Design: The Surveillance, Epidemiology, and End Results (SEER) database was queried for GIST and other intestinal mesenchymal tumors from 1992 to 2005. Results: A total of 3,795 patients with mesenchymal tumors were identified. More than 88% of tumors were identified as GIST after the year 2000. Overall, patient demographics showed 53% men, 72.2% Caucasians, 15.6% African Americans, and 9.1% Hispanics. In patients diagnosed before the year 2000, 30-day surgical mortality was higher in African Americans (0.56% versus 0.76% Caucasians, p = 0.012), although no difference was observed in tumor stage (p = 0.446) or grade (p = 0.495). African Americans underwent surgical extirpation less frequently (p = 0.003). Multivariate analysis correcting for patient demographics, socioeconomic status, and clinical data demonstrated African-American race (hazards ratio 1.66, p < 0.001) and failure to undergo surgical extirpation (hazards ratio 2.930, p < 0.001) were independent predictors of poor prognosis. In patients diagnosed after 2000, 30-day surgical mortality was equivalent between races (0.46% versus 0.35%, p = 0.517), and African Americans underwent surgical extirpation just as often as Caucasians did (p = 0.153). Multivariate analysis for patients diagnosed after 2000 demonstrated no difference in survival by race (hazards ratio 1.27, p = 0.126). Conclusions: Before 2000, African Americans were less likely to have surgery, and they demonstrated an overall increased mortality rate for GIST. Since 2000, African Americans have benefited from increased surgical resection rates, decreased perioperative mortality, and improved longterm survival. These changes have appeared to erase racial disparities in the treatment of GIST.

Original languageEnglish (US)
Pages (from-to)7-16
Number of pages10
JournalJournal of the American College of Surgeons
Volume209
Issue number1
DOIs
StatePublished - Jul 2009
Externally publishedYes

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Gastrointestinal Stromal Tumors
African Americans
Mortality
Demography
Social Class
Neoplasms
Multivariate Analysis
Survival
Hispanic Americans
Epidemiology
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Disappearance of Racial Disparities in Gastrointestinal Stromal Tumor Outcomes. / Cheung, Michael C.; Zhuge, Ying; Yang, Relin; Koniaris, Leonidas G.

In: Journal of the American College of Surgeons, Vol. 209, No. 1, 07.2009, p. 7-16.

Research output: Contribution to journalArticle

Cheung, Michael C. ; Zhuge, Ying ; Yang, Relin ; Koniaris, Leonidas G. / Disappearance of Racial Disparities in Gastrointestinal Stromal Tumor Outcomes. In: Journal of the American College of Surgeons. 2009 ; Vol. 209, No. 1. pp. 7-16.
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abstract = "Background: The purpose of this study was to determine the effects of race, socioeconomic status, and demographic and clinical variables on the outcomes of gastrointestinal stromal tumors (GISTs). Study Design: The Surveillance, Epidemiology, and End Results (SEER) database was queried for GIST and other intestinal mesenchymal tumors from 1992 to 2005. Results: A total of 3,795 patients with mesenchymal tumors were identified. More than 88{\%} of tumors were identified as GIST after the year 2000. Overall, patient demographics showed 53{\%} men, 72.2{\%} Caucasians, 15.6{\%} African Americans, and 9.1{\%} Hispanics. In patients diagnosed before the year 2000, 30-day surgical mortality was higher in African Americans (0.56{\%} versus 0.76{\%} Caucasians, p = 0.012), although no difference was observed in tumor stage (p = 0.446) or grade (p = 0.495). African Americans underwent surgical extirpation less frequently (p = 0.003). Multivariate analysis correcting for patient demographics, socioeconomic status, and clinical data demonstrated African-American race (hazards ratio 1.66, p < 0.001) and failure to undergo surgical extirpation (hazards ratio 2.930, p < 0.001) were independent predictors of poor prognosis. In patients diagnosed after 2000, 30-day surgical mortality was equivalent between races (0.46{\%} versus 0.35{\%}, p = 0.517), and African Americans underwent surgical extirpation just as often as Caucasians did (p = 0.153). Multivariate analysis for patients diagnosed after 2000 demonstrated no difference in survival by race (hazards ratio 1.27, p = 0.126). Conclusions: Before 2000, African Americans were less likely to have surgery, and they demonstrated an overall increased mortality rate for GIST. Since 2000, African Americans have benefited from increased surgical resection rates, decreased perioperative mortality, and improved longterm survival. These changes have appeared to erase racial disparities in the treatment of GIST.",
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