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J Gastrointest Oncol. 2018 Apr;9(2):231-240. doi: 10.21037/jgo.2017.11.12.

Distinctive features of gastrointestinal stromal tumors arising from the colon and rectum.

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Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing 100039, China.
Department of Cancer Registry, Yale New Haven Hospital, New Haven, CT, USA.
Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA.
Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT, USA.
Department of Surgery, Section of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.



Colon and rectal gastrointestinal stromal tumors (GISTs) are rare and poorly characterized. Because the majority of treatment guidelines for GISTs are extrapolated from tumors of gastric and small bowel origin, our aim was to better characterize the unique clinicopathologic features and prognostic factors of colon and rectal GISTs to guide clinical care.


The National Cancer Data Base (NCDB) was queried from 2006 to 2013 for cases of GISTs in the stomach, colon, and rectum. Patient demographics, clinical characteristics, and survival were compared.


A total of 11,302 gastric GISTs were compared to 398 colon and 393 rectal GISTs. After propensity matching, compared to gastric GISTs, rectal GISTs had improved overall survival (HR =0.695, P=0.0264), while colon GISTs had worse overall survival (HR =1.6, P=0.0005). Surgical treatment for rectal GISTs was more likely to be local excision compared to colonic GISTs (51.1% vs. 8.4%, P<0.0001). Colon and gastric GISTs were less likely to receive systemic therapy compared to rectal GISTs (34.2% vs. 34.0% vs. 55.2%, P<0.0001). Adjuvant systemic therapy conveyed a survival advantage to rectal GISTs (HR =0.47, P=0.042) but not colon GISTs. There was a negative impact of adjuvant therapy on survival for colon GISTs <5 cm (HR =3.41, P=0.032).


Patients with rectal GISTs live longer than those with colon and gastric GISTs, and adjuvant therapy prolongs their survival. Many patients with colon GISTs are treated with adjuvant therapy despite a detrimental effect on survival. Tumor biology of colon and rectal GISTs needs to be better studied to tailor treatment.


Gastrointestinal stromal tumors (GISTs); adjuvant therapy; colon; rectum; survival

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