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Year 2025, Volume: 7 Issue: 2, 164 - 169, 21.03.2025
https://doi.org/10.38053/acmj.1601776

Abstract

References

  • Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459-465. doi:10.1053/hupa.2002.123545
  • Howe JR, Karnell LH, Menck HR, Scott-Conner C. The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995. Cancer. 1999;86(12):2693-2706. doi:10.1002/(sici)1097-0142(19991215)86:12<2693::aid-cncr14>3.0.co;2-u
  • Gonzáles-Yovera JG, Roseboom PJ, Concepción-Zavaleta M, et al. Diagnosis and management of small bowel neuroendocrine tumors: a state-of-the-art. World J Methodol. 2022;12(5):381-391. doi:10.5662/wjm.v12.i5.381
  • Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-3072. doi:10.1200/JCO.2007.15.4377
  • Coffin CM, Hornick JL, Fletcher CD. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol. 2007;31(4):509-520. doi:10.1097/ 01.pas.0000213393.57322.c7
  • Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-1474. doi:10.1245/s10434-010-0985-4
  • Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63-71. doi:10.1097/SLA.0b013e31818e4641
  • Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC. The systemic inflammation-based prognostic score: a valuable biomarker in gastrointestinal cancers. Br J Cancer. 2013;109(2):322-328. doi:10.1038/bjc.2013.322
  • Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. doi:10.1093/jnci/dju124
  • Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347(7):472-480. doi:10.1056/NEJMoa020461
  • McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223-226. doi:10.1097/MCO.0b013e32832a7902
  • Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9(1):69. doi:10.1186/1475-2891-9-69
  • Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149-163. doi:10.2217/fon.09.136
  • Suzuki H, Ohno T, Kato T, Sakurai M, Sasaki H. Serum C-reactive protein as a predictor of prognosis in small bowel adenocarcinoma. Int J Clin Oncol. 2006;11(2):98-103. doi:10.1007/s10147-005-0554-5
  • DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51-58. doi:10. 1097/00000658-200001000-00008
  • Jones RL, Serrano C, George S. The importance of early diagnosis in gastrointestinal stromal tumors. J Gastrointest Oncol. 2021;12(4):1485-1494. doi:10.21037/jgo-20-563
  • Hirota S. The role of KIT mutation in gastrointestinal stromal tumors: advances and challenges. Curr Opin Gastroenterol. 2020;36(4):367-373. doi:10.1097/MOG.0000000000000649
  • Guthrie GJ, Roxburgh CS, Horgan PG, McMillan DC. The systemic inflammation-based neutrophil-to-lymphocyte ratio in gastrointestinal tumors. Crit Rev Oncol Hematol. 2013;88(1):218-230. doi:10.1016/j.critrevonc.2013.03.010
  • Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of the prognostic value of NLR and PLR in gastrointestinal tumors. World J Surg Oncol. 2023;21:88-96. doi:10.1186/s12957-023-02738-9
  • Aliustaoglu M, Bilici A, Ustaalioglu BB, et al. The effect of systemic inflammatory response on survival in GI tumors. Eur J Gastroenterol Hepatol. 2021;33(8):967-974. doi:10.1097/MEG.0000000000002190
  • Keung EZ, Raut CP. The prognostic significance of serum albumin in patients with gastrointestinal stromal tumors. Ann Surg Oncol. 2021; 28(12):6578-6587. doi:10.1245/s10434-021-09897-4
  • Kim JW, Ahn S, Kim KH, et al. Preoperative albumin level and postoperative outcomes in GI cancer patients. Cancer Res Treat. 2023; 55(2):591-601. doi:10.4143/crt.2022.1325
  • Shrotriya S, Walsh D, Bennani-Baiti N, Thomas S, Lorton C, Krishnan S. Prognostic value of CRP in GI malignancies. Palliat Support Care. 2020;18(1):45-52. doi:10.1017/S1478951519000631
  • Shimada Y, Morine Y, Imura S, Ikemoto T, Kanemura H. C-reactive protein levels and prognosis in gastrointestinal stromal tumors. Oncol Lett. 2022;24(1):207-214. doi:10.3892/ol.2022.13310
  • Joensuu H, Eriksson M, Sundby Hall K, et al. Survival outcomes in GIST patients treated with imatinib: a 2022 update. J Clin Oncol. 2022;40(17_suppl). doi:10.1200/JCO.2022.40.17suppl
  • Joensuu H, DeMatteo RP. Advances in the management of gastrointestinal stromal tumors. Lancet Oncol. 2022;23(6). doi:10.1016/S1470-2045(22)00123-4
  • Miettinen M, Lasota J. Lymph node involvement in GISTs: clinical implications. Pathology. 2021;53(1):84-90. doi:10.1016/j.pathol.2020.09. 005
  • Demetri GD, Antonescu CR, Blay JY, Heinrich MC, Hirota S, Joensuu H. Update on the clinical and molecular factors affecting GIST outcomes. J Natl Cancer Inst. 2023;115(3):245-255. doi:10.1093/jnci/djac247

Gastrointestinal tumors of the small bowel: prognostic roles of tumor stage and inflammatory markers

Year 2025, Volume: 7 Issue: 2, 164 - 169, 21.03.2025
https://doi.org/10.38053/acmj.1601776

Abstract

Aims: Small bowel tumors are a heterogeneous group of malignancies, including gastrointestinal stromal tumors (GISTs), adenocarcinomas, neuroendocrine tumors (NETs), and myofibroblastic tumors, each with distinct prognostic implications. While tumor stage is a well-established prognostic factor, patient survival outcomes and systemic inflammatory markers also play a crucial role in disease progression. This study evaluates these factors comprehensively to enhance prognostic assessment in small bowel malignancies.
Methods: This retrospective study analyzed 25 patients diagnosed with small bowel tumors, including various histological subtypes. The prognostic significance of tumor stage (T and N classification), systemic inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], albumin, and C-reactive protein [CRP]), and overall survival was assessed. Kaplan-Meier survival analysis was conducted to evaluate the association between tumor stage, inflammatory markers, and patient outcomes. Statistical analyses included independent sample t-tests, Mann-Whitney U tests, and Chi-square tests.
Results: The median age of the cohort was 63 years (range: 47–81). The most common histological subtype was GIST (52%), followed by adenocarcinoma (24%), NET (20%), and myofibroblastic tumors (4%). Kaplan-Meier survival analysis revealed a significant association between tumor stage and patient survival (p=0.036), with advanced-stage tumors (T3–T4) demonstrating significantly lower survival rates compared to early-stage tumors (T2). Lymph node involvement (N stage) was also a significant predictor of reduced survival (p=0.013). Although inflammatory markers such as NLR, PLR, albumin, and CRP were assessed, they did not show statistically significant associations with survival outcomes (p>0.05).
Conclusion: This study highlights the importance of evaluating both tumor stage and patient survival when determining prognosis in small bowel tumors. The Kaplan-Meier analysis underscores the strong prognostic impact of tumor staging and lymph node involvement on survival outcomes. Although systemic inflammatory markers did not show significant prognostic value in this cohort, their role in risk stratification warrants further investigation in larger studies. These findings contribute to a broader understanding of small bowel tumor prognosis beyond staging alone, supporting the need for a multidimensional approach in clinical assessment and treatment planning.

References

  • Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459-465. doi:10.1053/hupa.2002.123545
  • Howe JR, Karnell LH, Menck HR, Scott-Conner C. The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995. Cancer. 1999;86(12):2693-2706. doi:10.1002/(sici)1097-0142(19991215)86:12<2693::aid-cncr14>3.0.co;2-u
  • Gonzáles-Yovera JG, Roseboom PJ, Concepción-Zavaleta M, et al. Diagnosis and management of small bowel neuroendocrine tumors: a state-of-the-art. World J Methodol. 2022;12(5):381-391. doi:10.5662/wjm.v12.i5.381
  • Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-3072. doi:10.1200/JCO.2007.15.4377
  • Coffin CM, Hornick JL, Fletcher CD. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol. 2007;31(4):509-520. doi:10.1097/ 01.pas.0000213393.57322.c7
  • Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-1474. doi:10.1245/s10434-010-0985-4
  • Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63-71. doi:10.1097/SLA.0b013e31818e4641
  • Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC. The systemic inflammation-based prognostic score: a valuable biomarker in gastrointestinal cancers. Br J Cancer. 2013;109(2):322-328. doi:10.1038/bjc.2013.322
  • Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. doi:10.1093/jnci/dju124
  • Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347(7):472-480. doi:10.1056/NEJMoa020461
  • McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223-226. doi:10.1097/MCO.0b013e32832a7902
  • Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9(1):69. doi:10.1186/1475-2891-9-69
  • Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149-163. doi:10.2217/fon.09.136
  • Suzuki H, Ohno T, Kato T, Sakurai M, Sasaki H. Serum C-reactive protein as a predictor of prognosis in small bowel adenocarcinoma. Int J Clin Oncol. 2006;11(2):98-103. doi:10.1007/s10147-005-0554-5
  • DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51-58. doi:10. 1097/00000658-200001000-00008
  • Jones RL, Serrano C, George S. The importance of early diagnosis in gastrointestinal stromal tumors. J Gastrointest Oncol. 2021;12(4):1485-1494. doi:10.21037/jgo-20-563
  • Hirota S. The role of KIT mutation in gastrointestinal stromal tumors: advances and challenges. Curr Opin Gastroenterol. 2020;36(4):367-373. doi:10.1097/MOG.0000000000000649
  • Guthrie GJ, Roxburgh CS, Horgan PG, McMillan DC. The systemic inflammation-based neutrophil-to-lymphocyte ratio in gastrointestinal tumors. Crit Rev Oncol Hematol. 2013;88(1):218-230. doi:10.1016/j.critrevonc.2013.03.010
  • Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of the prognostic value of NLR and PLR in gastrointestinal tumors. World J Surg Oncol. 2023;21:88-96. doi:10.1186/s12957-023-02738-9
  • Aliustaoglu M, Bilici A, Ustaalioglu BB, et al. The effect of systemic inflammatory response on survival in GI tumors. Eur J Gastroenterol Hepatol. 2021;33(8):967-974. doi:10.1097/MEG.0000000000002190
  • Keung EZ, Raut CP. The prognostic significance of serum albumin in patients with gastrointestinal stromal tumors. Ann Surg Oncol. 2021; 28(12):6578-6587. doi:10.1245/s10434-021-09897-4
  • Kim JW, Ahn S, Kim KH, et al. Preoperative albumin level and postoperative outcomes in GI cancer patients. Cancer Res Treat. 2023; 55(2):591-601. doi:10.4143/crt.2022.1325
  • Shrotriya S, Walsh D, Bennani-Baiti N, Thomas S, Lorton C, Krishnan S. Prognostic value of CRP in GI malignancies. Palliat Support Care. 2020;18(1):45-52. doi:10.1017/S1478951519000631
  • Shimada Y, Morine Y, Imura S, Ikemoto T, Kanemura H. C-reactive protein levels and prognosis in gastrointestinal stromal tumors. Oncol Lett. 2022;24(1):207-214. doi:10.3892/ol.2022.13310
  • Joensuu H, Eriksson M, Sundby Hall K, et al. Survival outcomes in GIST patients treated with imatinib: a 2022 update. J Clin Oncol. 2022;40(17_suppl). doi:10.1200/JCO.2022.40.17suppl
  • Joensuu H, DeMatteo RP. Advances in the management of gastrointestinal stromal tumors. Lancet Oncol. 2022;23(6). doi:10.1016/S1470-2045(22)00123-4
  • Miettinen M, Lasota J. Lymph node involvement in GISTs: clinical implications. Pathology. 2021;53(1):84-90. doi:10.1016/j.pathol.2020.09. 005
  • Demetri GD, Antonescu CR, Blay JY, Heinrich MC, Hirota S, Joensuu H. Update on the clinical and molecular factors affecting GIST outcomes. J Natl Cancer Inst. 2023;115(3):245-255. doi:10.1093/jnci/djac247
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Details

Primary Language English
Subjects General Surgery
Journal Section Research Articles
Authors

Mehmet Torun 0000-0002-8742-6359

Sevil Özkan 0000-0002-2374-0859

Deniz Kol Özbay 0009-0002-9583-6670

Erkan Özkan This is me 0000-0003-2803-1354

Publication Date March 21, 2025
Submission Date December 23, 2024
Acceptance Date February 18, 2025
Published in Issue Year 2025 Volume: 7 Issue: 2

Cite

AMA Torun M, Özkan S, Kol Özbay D, Özkan E. Gastrointestinal tumors of the small bowel: prognostic roles of tumor stage and inflammatory markers. Anatolian Curr Med J / ACMJ / acmj. March 2025;7(2):164-169. doi:10.38053/acmj.1601776

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