Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 5, pp 1035–1043 | Cite as

Racial Disparity in Incidence and Survival for Gastrointestinal Stromal Tumors (GISTs): an Analysis of SEER Database

  • Mark B. UlanjaEmail author
  • Mohit Rishi
  • Bryce D. Beutler
  • Kenneth G. Konam
  • Santhosh Ambika
  • Tomas Hinojosa
  • Francis T. Djankpa
  • Wei Yang
  • Nageshwara Gullapalli



Gastrointestinal tumors (GISTs) represent the most common mesenchymal tumors of the gastrointestinal tract. There has been limited data on GIST incidence and survival disparities between ethnic groups.


Assess disparities in incidence and survival among race in the USA in the era of available GIST histologic codes and treatment.


We queried Surveillance, Epidemiology, and End Results (SEER) database for GIST from 2002 to 2015, with diagnostic code 8936.


Of the 7204 patients identified, 4928 (68.4%) were White, 1308 (18.2%) African American (AA), and 968 (13.4%) were classified as “Other” (American Indian/Alaskan Native, Asian/Pacific Islander). The overall incidence rate (IR) was 0.75 per 100,000. IR was highest among AA at 1.37/100,000, but 0.65/100,000 for Whites, 1.10/100,000 for Asians/Pacific Islanders, and 0.28/100,000 for American Indians/Alaskan Natives. The GIST incidence was twice as high for AA as for Whites (rate ratio [RR]: 2.12; 95% CI: 1.98–2.26; p < 0.001). There was higher proportion of Whites than AA, who underwent surgical extirpation. Median overall survival (OS) and GIST specific survival (GSS) were not reached for all race, which indicates more than half of the patients were still alive at end of follow-up period. In multivariate Cox model, belonging to “Other” had better OS (adjusted hazard ratio [aHR]; 0.73, 95% CI: 0.55–0.95, P = 0.021) for GIST, but no difference in prognosis and OS for AA and White [(aHR for whites; 0.84, 95% CI: 0.69–1.02, P = 0.071), AA = reference]. There was no difference in GSS among races.


Significant racial disparity in incidence and overall survival for GIST exists, and efforts should be made to bridge this gap and improve outcomes for all races. The overall incidence rate for GIST was noted to be 7.5 per 1 million, and IR of GIST was twice as high for African Americans as compared to Whites. The “Other” racial group (American Indians/Alaskan Natives, Asians, and Pacific Islanders) had superior OS as compared to African Americans and Whites.


Surveillance epidemiology and end results Gastrointestinal stromal tumors Race disparity Median survival Incidence rate Incidence of GIST 



We are thankful to Paschal Apanga (University of Nevada, Reno) for his help and suggestions.

Authors’ Contribution

MBU, MR, BDB, TH, and GN conceived the idea and prepared manuscript. MR, KGK, MBU drafted the initial manuscript. MBU performed the computations. WY helped with computation and statistical analysis. TD helped with manuscript writing. SA, NG, TH guided the preparation process and writing of the manuscript. All authors read and approved of the manuscript prior to publication.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

There was no IRB approval needed for this research, as it utilizes public, de-identified data.

Supplementary material

40615_2019_605_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)


  1. 1.
    Perez EA, Livingstone AS, Franceschi D, Rocha-Lima C, Lee DJ, Hodgson N, et al. Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg. 2006;202(4):623–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100(1):162–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Blanke C, Eisenberg BL, Heinrich M. Epidemiology of GIST. Am J Gastroenterol. 2005;100(10):2366.CrossRefPubMedGoogle Scholar
  4. 4.
    Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279(5350):577–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Khanna A, et al. Is adjuvant 5-FU-based chemoradiotherapy for resectable pancreatic adenocarcinoma beneficial? A meta-analysis of an unanswered question. J Gastrointest Surg. 2006;10(5):689–97.CrossRefPubMedGoogle Scholar
  6. 6.
    DeMatteo RP, et al. Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor: ACOSOG Z9000 (Alliance) intergroup phase 2 trial. Ann Surg. 2013;258(3):422–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cheung MC, Zhuge Y, Yang R, Koniaris LG. Disappearance of racial disparities in gastrointestinal stromal tumor outcomes. J Am Coll Surg. 2009;209(1):7–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Day JC. Population projections of the United States, by age, sex, race, and Hispanic origin: 1992 to 2050. Bureau: US Department of Commerce, Economics and Statistics Administration; 1992.Google Scholar
  9. 9.
    Tiwari RC, Clegg LX, Zou Z. Efficient interval estimation for age-adjusted cancer rates. Stat Methods Med Res. 2006;15(6):547–69.CrossRefPubMedGoogle Scholar
  10. 10.
    Ma GL, Murphy JD, Martinez ME, Sicklick JK. Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study. Cancer Epidemiol Prev Biomarkers. 2015;24(1):298–302.CrossRefGoogle Scholar
  11. 11.
    Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005;29(1):52–68.CrossRefPubMedGoogle Scholar
  12. 12.
    de Raedt T, Cools J, Debiec–Rychter M, Brems H, Mentens N, Sciot R, et al. Intestinal neurofibromatosis is a subtype of familial GIST and results from a dominant activating mutation in PDGFRA. Gastroenterology. 2006;131(6):1907–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Fletcher CD, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Pathol. 2002;10(2):81–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Din OS, Woll PJ. Treatment of gastrointestinal stromal tumor: focus on imatinib mesylate. Ther Clin Risk Manag. 2008;4(1):149–62.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer. 2005;103(4):821–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Tryggvason G, Gíslason HG, Magnússon MK, Jónasson JG. Gastrointestinal stromal tumors in Iceland, 1990-2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer. 2005;117(2):289–93.CrossRefPubMedGoogle Scholar
  17. 17.
    Leoncini E, Carioli G, la Vecchia C, Boccia S, Rindi G. Risk factors for neuroendocrine neoplasms: a systematic review and meta-analysis. Ann Oncol. 2016;27(1):68–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Miettinen M, Fetsch JF, Sobin LH, Lasota J. Gastrointestinal stromal tumors in patients with neurofibromatosis 1: a clinicopathologic and molecular genetic study of 45 cases. Am J Surg Pathol. 2006;30(1):90–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Ashktorab H, Kupfer SS, Brim H, Carethers JM. Racial disparity in gastrointestinal Cancer risk. Gastroenterology. 2017;153(4):910–23.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kawanowa K, et al. High incidence of microscopic gastrointestinal stromal tumors in the stomach. Hum Pathol. 2006;37(12):1527–35.CrossRefPubMedGoogle Scholar
  21. 21.
    Dong E, Duan L, Wu BU. Racial and ethnic minorities at increased risk for gastric Cancer in a regional US population study. Clin Gastroenterol Hepatol. 2017;15(4):511–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Nguyen T, Ramsey D, Graham D, Shaib Y, Shiota S, Velez M, et al. The prevalence of helicobacter pylori remains high in African American and Hispanic veterans. Helicobacter. 2015;20(4):305–15.CrossRefPubMedGoogle Scholar
  23. 23.
    Li K, et al. Genetic progression in gastrointestinal stromal tumors: mechanisms and molecular interventions. Oncotarget. 2017;8(36):60589–604.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Giuliano K, Nagarajan N, Canner J, Najafian A, Wolfgang C, Schneider E, et al. Gastric and small intestine gastrointestinal stromal tumors: do outcomes differ? J Surg Oncol. 2017;115(3):351–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Bolen JC, et al. State-specific prevalence of selected health behaviors, by race and ethnicity--behavioral risk factor surveillance system, 1997. MMWR CDC Surveill Summ. 2000;49(2):1–60.PubMedGoogle Scholar
  27. 27.
    Freeman HP. Poverty, culture, and social injustice: determinants of cancer disparities. CA Cancer J Clin. 2004;54(2):72–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Henschke UK, Leffall LD, Mason CH, Reinhold AW, Schneider RL, White JE. Alarming increase of the cancer mortality in the U.S. black population (1950-1967). Cancer. 1973;31(4):763–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Nikfarjam M, Kimchi E, Shereef S, Gusani NJ, Jiang Y, Liang J, et al. Surgical outcomes of patients with gastrointestinal stromal tumors in the era of targeted drug therapy. J Gastrointest Surg. 2008;12(11):2023–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Geiger HJ. Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. Unequal Treat. 2003;417.Google Scholar
  31. 31.
    Dimick J, Ruhter J, Sarrazin MV, Birkmeyer JD. Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff (Millwood). 2013;32(6):1046–53.CrossRefGoogle Scholar
  32. 32.
    Haider AH, et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg. 2013;216(3):482–92 e12.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Rubin JL, Sanon M, Taylor DC, Coombs J, Bollu V, Sirulnik L. Epidemiology, survival, and costs of localized gastrointestinal stromal tumors. Int J Gen Med. 2011;4:121–30.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Ng EH, et al. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging. Ann Surg. 1992;215(1):68–77.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    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):51–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Joensuu H, et al. Adjuvant imatinib for high-risk GI stromal tumor: analysis of a randomized trial. J Clin Oncol. 2015;34(3):244–50.CrossRefPubMedGoogle Scholar
  37. 37.
    Kelley RK, Venook AP. Nonadherence to imatinib during an economic downturn. N Engl J Med. 2010;363(6):596–8.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Mark B. Ulanja
    • 1
    Email author
  • Mohit Rishi
    • 1
  • Bryce D. Beutler
    • 1
  • Kenneth G. Konam
    • 2
  • Santhosh Ambika
    • 1
    • 3
  • Tomas Hinojosa
    • 4
  • Francis T. Djankpa
    • 5
  • Wei Yang
    • 6
  • Nageshwara Gullapalli
    • 1
  1. 1.Department of Internal MedicineUniversity of Nevada, Reno School of MedicineRenoUSA
  2. 2.College of Arts and SciencesVanderbilt UniversityNashvilleUSA
  3. 3.Renown Institute for CancerRenoUSA
  4. 4.VA Sierra Nevada Health Care SystemRenoUSA
  5. 5.Uniformed Services University of the Health SciencesBethesdaUSA
  6. 6.Center for Surveys, Evaluation and Statistics, School of Community Health SciencesUniversity of Nevada, RenoRenoUSA

Personalised recommendations