ACMJ
Anatolian Current Medical Journal

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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

Keywords : Gastrointestinal stromal tumors (GISTs), inflammatory markers, tumor stage, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), survival analysis, gastrointestinal tumors, prognostic factors

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1. 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
2. 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
3. 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
4. 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
5. 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
6. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7<sup>th</sup> 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
7. 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
8. 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
9. Templeton AJ, McNamara MG, &Scaron;eruga 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
25. 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
26. 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
27. 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
28. 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
Article available in :
Volume 7, Issue 2, 2025
Page : 164-169
https://doi.org/10.38053/acmj.1601776
Article Information
Received : 23 Ara 2024
Accepted : 18 Şub 2025
Published : 21 Mar 2025
Corresponding Author :

Mehmet Torun: Department of Gastrointestinal Surgery, Erzurum State Hospital, Erzurum, Turkiye

[email protected]
Citation : 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. 2025;7(2):164-169.

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