Nationwide trends in the incidence and outcome of patients with gastrointestinal stromal tumour in the imatinib era.

BACKGROUND: The incidence, treatment and outcome of patients with newly diagnosed gastrointestinal stromal tumour (GIST) were studied in an era known for advances in diagnosis and treatment. METHODS: Nationwide population-based data were retrieved from the Netherlands Cancer Registry. All patients with GIST diagnosed between 2001 and 2012 were included. Primary treatment, defined as any treatment within the first 6-9 months after diagnosis, was studied. Age-standardized incidence was calculated according to the European standard population. Changes in incidence were evaluated by calculating the estimated annual percentage change (EAPC). Relative survival was used for survival calculations with follow-up available to January 2017. RESULTS: A total of 1749 patients (54·0 per cent male and median age 66 years) were diagnosed with a GIST. The incidence of non-metastatic GIST increased from 3·1 per million person-years in 2001 to 7·0 per million person-years in 2012; the EAPC was 7·1 (95 per cent c.i. 4·1 to 10·2) per cent (P < 0·001). The incidence of primary metastatic GIST was 1·3 per million person-years, in both 2001 and 2012. The 5-year relative survival rate increased from 71·0 per cent in 2001-2004 to 81·4 per cent in 2009-2012. Women had a better outcome than men. Overall, patients with primary metastatic GIST had a 5-year relative survival rate of 48·2 (95 per cent c.i. 42·0 to 54·2) per cent compared with 88·8 (86·0 to 91·4) per cent in those with non-metastatic GIST. CONCLUSION: This population-based nationwide study found an incidence of GIST in the Netherlands of approximately 8 per million person-years. One in five patients presented with metastatic disease, but relative survival improved significantly over time for all patients with GIST in the imatinib era.

Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: A nationwide retrospective study.

INTRODUCTION: Liver metastases are common in patients with gastrointestinal stromal tumors (GIST). In the absence of randomized controlled clinical trials, the effectiveness of surgery as a treatment modality is unclear. This study identifies safety and outcome in a nationwide study of all patients who underwent resection of liver metastases from GIST. METHODS: Patients were included using the national registry of histo- and cytopathology (PALGA) of the Netherlands from 1999. Kaplan Meier survival analysis was used for calculating survival outcome. Univariate and multivariate regression analyses were carried out for the assessment of potential prognostic factors. RESULTS: A total of 48 patients (29 male, 19 female) with a median age of 58 (range 28-81) years were identified. Preoperative and postoperative tyrosine kinase inhibitor therapy was given to 30 (63%) and 36 (75%) patients, respectively. A minor liver resection was performed in 32 patients, 16 patients underwent major liver resection. Median follow-up was 27 (range 1-146) months. Median progression-free survival (PFS) was 28 (range 1-121) months. One-, three-, and five-year PFS was 93%, 67%, and 59% respectively. Median overall survival (OS) was 90 (range 1-146) months from surgery. The one-, three-, and five-year OS was 93%, 80%, and 76% respectively. R0 resection was the only independent significant prognostic factor for DFS and OS at multivariate analysis. CONCLUSION: Resection of liver metastases in GIST patients combined with imatinib may be associated with prolonged overall survival when a complete resection is achieved.

Transanal endoscopic microsurgery following treatment with imatinib : a case report of a patient with a rectal gastrointestinal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumors (GIST) of the rectum are a challenge for the colorectal surgeon. In case of a locally advanced rectal GIST, an extended or multivisceral resection with significant morbidity and -mortality is often necessary. Literature is lacking on the combined modality of transanal endoscopisc microsurgery (TEM) following imatinib for these patients. METHODS: We describe a combined approach for a locally advanced GIST of the rectum with preoperative imatinib -treatment and subsequent local excision using the TEM procedure. RESULTS: After six months of treatment with imatinib the TEM procedure was successfully performed with a radical -resection of the remnant tumor. Twenty-four months after surgery this patient has no evidence of disease. CONCLUSIONS: A TEM procedure following treatment with imatinib may safely be performed in selected patients with a locally advanced GIST.

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal tumours after treatment with imatinib.

AIMS: Patients with locally advanced gastrointestinal stromal tumours (GISTs) have a high risk of tumour perforation, incomplete tumour resections and often require multivisceral resections. Long-term disease-free and overall survival is usually impaired in this group of patients. Induction therapy with imatinib followed by surgery seems to be beneficial in terms of improved surgical results and long-term outcome. We report on a large cohort of locally advanced GIST patients who have been treated in four centres in the Netherlands specialized in the treatment of sarcomas. METHODS: Between August 2001 and June 2011, 57 patients underwent surgery for locally advanced GISTs after imatinib treatment. Data of all patients were retrospectively collected. Endpoints were progression-free and overall survival. RESULTS: The patients underwent surgery after a median of 8 (range 1-55) months of imatinib treatment. Median tumour size before treatment was 12.2 (range 5.2-30) cm and reduced to 6.2 (range 1-20) cm before surgery. No tumour perforation occurred and a surgical complete (R0) resection was achieved in 48 (84%) patients. Five-year PFS and OS were 77% and 88%. Eight patients had recurrent/metastatic disease. CONCLUSIONS: Imatinib in locally advanced GIST is feasible and enables a high complete resection rate without tumour rupture. The combination of imatinib and surgery in patients with locally advanced GIST seems to improve PFS and OS.

A decade of growth in public and private pharmaceutical expenditures: the case of Belgium 1990-1999.

OBJECTIVE: To make a systematic, transparent, internationally comparable description of trends (1990-1999) in total, public and private (co-payment + out-of-pocket) spending on pharmaceuticals in Belgium. SETTING: Belgium, a western European country, with a Bismarck-type universal coverage healthcare system. NATURE OF THE STUDY: Descriptive analysis of time-series. METHODS: Collaborative data gathering effort between academic and private research institutes and IMS health. RESULTS: Mean annual growth rate was 3.9% for total, 5.3% for public, and 2.0% for private drug expenditures (expressed in constant 1999 EUR). The ratio of public to private spending shifted from 53.4% to 60.3%. Of the private spending, one third was co-payment for reimbursed medication and two thirds was out-of-pocket payment for non-reimbursed medication. CONCLUSION: Co-operation between several data gathering constituencies within one country was necessary to achieve completeness and detail in data collection on out-of-pocket payments for non-reimbursed medicines, and hence in total drug expenditures. Discrepancies were found between the estimate of the public/private mix and OECD health data 2000 for public drug spending.

The demographic impact on ambulatory pharmaceutical expenditure in Belgium.

It has become customary in our society to attribute the rise in health care expenditure to a large extent to the aging of the population. The Belgian Institute of Health Economics (BIGE-IBES) finalised a study to measure the impact of the demographic trend on public spending for ambulatory pharmaceuticals. The results show that the changes in age structure as such have a relatively small impact on health care expenditure. Over the period 1986-1996 an annual growth of +0.73% was observed, while total public spending showed an annual average increase of +6.2% (in constant francs 1996). This first static demographic impact will become +0.75% per year for the next decade 1996-2006. It is, however, possible to calculate the extent to which per capita expenditure envolved differently according to age group: over 1986-1996 expenditure for the elderly was rising more sharply than for the younger age groups. This leads to a second dynamic demographic impact which will cause an annual growth rate of +1.91% for the next decade, according to the working hypothesis put forward. This growth rate is to be compared with the authorized budgetary increase of +1.5% per year (inflation excluded), according to the EU-Maastricht quotes..., and it does even not take into account the other increasing factors as technological innovation and epidemiological needs.