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Gastrointestinal Stromal Tumors Outcomes in Afro-Caribbean Immigrants Are Impacted by Social and Economic Status
Francesco Serafini^*, Rebecca M. Miller, Thomas Mcintyre, Muthukumar Muthusamy
Kings County Hospital Center, Brooklyn, NY

Introduction: Previous studies have reported that outcomes of patients with Gastrointestinal Stromal Tumors (GIST) are not impacted by racial disparities. In this study, we characterized the clinical features and outcomes of GIST tumors in a homogeneous immigrant Afro-Caribbean population with indices of low socio-economic status. Subsequently, we compared our results with SEER data and with a large homogeneous European population. Methods: We reviewed our Afro-Caribbean patients with GIST treated from 01/2002 to 07/2013. Low socio-economic status was assigned for uninsured and Medicaid patients. Measured outcomes were risk class according to Fletcher-NIH consensus criteria, rate of metastasis, resectability, and disease-free survival. Comparisons were made using Fisher's Exact Test and Columns Proportions Tests. Statistical significance was accepted at p<0.05. Results: We identified 52 patients with GIST, of which 37 were Afro-Caribbean. 84% had Medicaid (51%) or were uninsured (33%). Mean age was 65 years (39-86), stomach was the primary site in 76%. Bleeding was present in 86% and pain in 65% of patients. Metastases were found in 36% of patients at presentation, compared to 24% in the SEER (p=0.3), 11% in the Swedish (p=0.001) studies. Resection was undertaken in 78% compared to 81% in SEER data and 86% Swedish studies (p =NS). Three year disease-free survival was 56% compared to 79% in the SEER data (p<.05). Conclusions: Our Afro-Caribbean patients presented with more advanced disease, and despite aggressive treatment, they experienced worse outcomes compared to other ethnicities. Racial diversities and socio-economic status are important determinant of outcomes in patients with GIST.

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