Long-term oncologic outcomes following endoscopic versus surgical resection for GISTs: a propensity score matching analysis in the SEER database

Gastrointestinal stromal tumors (GISTs) are common tumors of the gastrointestinal tract. Endoscopic resection offers minimally invasive advantages, but its long-term outcomes versus surgery remain unclear. This study aims to evaluate the survival outcomes of endoscopic versus surgical resection for gastric GISTs. Patients with gastric GIST (2000–2022) were identified from the SEER database and classified into endoscopic and surgical groups. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups after propensity score matching (PSM), followed by multivariable analysis and subgroup tests. 5,750 patients were identified, with 740 patients in each group after PSM. Following PSM, no differences were observed between two groups in OS (HR = 1.08, P = 0.521) or CSS (HR = 1.332, P = 0.161). Multivariable analysis revealed that older age, underwent procedure during 2000–2011, grade III/IV, chemotherapy, and larger tumor size were associated with poorer CSS. Older age, male, unmarried status, cardia and overlapping location, and grade III/IV were associated with worse OS. Subgroup analyses and interaction testing demonstrated no survival differences across all predefined subgroups. In patients with gastric GIST, no differences were identified in OS or CSS between endoscopic and surgical resection, suggesting that endoscopic therapy may provide long-term survival that is non-inferior to surgical resection.