Shinsuke Sato1, Toshimasa Tsujinaka2, Toru Masuzawa3, Kazuyoshi Yamamoto4, Tsuyoshi Takahashi5, Yoshito Yamashita6, Junya Fujita7, Masakazu Takagi8, Seiichi Hirota9, Toshirou Nishida10. 1. Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan. shinsukesato@gmail.com. 2. Department of Surgery, Kaizuka City Hospital, Osaka, Japan. 3. Department of Surgery, Osaka Police Hospital, Osaka, Japan. 4. Department of Surgery, Osaka National Hospital, Osaka, Japan. 5. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 6. Department of Surgery, Osaka City General Hospital, Osaka, Japan. 7. Department of Surgery, NTT West Osaka Hospital, Osaka, Japan. 8. Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan. 9. Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan. 10. Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan.
Abstract
PURPOSE: To define the role of surgery for metastatic/recurrent lesions after resection of primary gastrointestinal stromal tumors (GISTs). METHODS: Based on data obtained from the Kinki GIST registry, patients with recurrence or metastasis were divided into a surgical treatment group (ST group), comprised those treated with surgery in addition to tyrosine kinase inhibitor (TKI) therapy; and a drug treatment group (DT group), comprised those treated with TKI therapy alone. We compared the baseline characteristics and survival outcomes of the groups. RESULTS: Metastasis or recurrence developed in 93 of the 737 patients with GISTs treated between 2003 and 2007, 50 (53.8 %) of whom were assigned to the ST group and 43 (46.2 %) to the DT group. In the ST group, the 5-year overall survival rate was significantly higher for patients who underwent R0/R1 resection than for those who underwent R2 resection (82.2 vs. 47.0 %, p = 0.018). Survival time after recurrence was correlated with the duration of total TKI therapy in both the ST and DT groups (r = 0.766 and r = 0.932, respectively, p < 0.001). CONCLUSIONS: Continuous TKI therapy appears to be important primarily for the prognostic improvement of patients with recurrent/metastatic GISTs. R0/R1 resection may have benefits when combined with TKI therapy for patients with stable disease or disease responsive to TKI therapy, less than four metastatic lesions, and lesions <100 mm in total.
PURPOSE: To define the role of surgery for metastatic/recurrent lesions after resection of primary gastrointestinal stromal tumors (GISTs). METHODS: Based on data obtained from the Kinki GIST registry, patients with recurrence or metastasis were divided into a surgical treatment group (ST group), comprised those treated with surgery in addition to tyrosine kinase inhibitor (TKI) therapy; and a drug treatment group (DT group), comprised those treated with TKI therapy alone. We compared the baseline characteristics and survival outcomes of the groups. RESULTS:Metastasis or recurrence developed in 93 of the 737 patients with GISTs treated between 2003 and 2007, 50 (53.8 %) of whom were assigned to the ST group and 43 (46.2 %) to the DT group. In the ST group, the 5-year overall survival rate was significantly higher for patients who underwent R0/R1 resection than for those who underwent R2 resection (82.2 vs. 47.0 %, p = 0.018). Survival time after recurrence was correlated with the duration of total TKI therapy in both the ST and DT groups (r = 0.766 and r = 0.932, respectively, p < 0.001). CONCLUSIONS: Continuous TKI therapy appears to be important primarily for the prognostic improvement of patients with recurrent/metastatic GISTs. R0/R1 resection may have benefits when combined with TKI therapy for patients with stable disease or disease responsive to TKI therapy, less than four metastatic lesions, and lesions <100 mm in total.
Authors: Ryan S Turley; Peter D Peng; Srinevas K Reddy; Andrew S Barbas; David A Geller; J Wallis Marsh; Allan Tsung; Timothy M Pawlik; Bryan M Clary Journal: Cancer Date: 2011-11-15 Impact factor: 6.860
Authors: George D Demetri; Margaret von Mehren; Charles D Blanke; Annick D Van den Abbeele; Burton Eisenberg; Peter J Roberts; Michael C Heinrich; David A Tuveson; Samuel Singer; Milos Janicek; Jonathan A Fletcher; Stuart G Silverman; Sandra L Silberman; Renaud Capdeville; Beate Kiese; Bin Peng; Sasa Dimitrijevic; Brian J Druker; Christopher Corless; Christopher D M Fletcher; Heikki Joensuu Journal: N Engl J Med Date: 2002-08-15 Impact factor: 91.245
Authors: George D Demetri; Peter Reichardt; Yoon-Koo Kang; Jean-Yves Blay; Piotr Rutkowski; Hans Gelderblom; Peter Hohenberger; Michael Leahy; Margaret von Mehren; Heikki Joensuu; Giuseppe Badalamenti; Martin Blackstein; Axel Le Cesne; Patrick Schöffski; Robert G Maki; Sebastian Bauer; Binh Bui Nguyen; Jianming Xu; Toshirou Nishida; John Chung; Christian Kappeler; Iris Kuss; Dirk Laurent; Paolo G Casali Journal: Lancet Date: 2012-11-22 Impact factor: 79.321
Authors: Rebecca M Platoff; William F Morano; Luiz Marconcini; Nicholas DeLeo; Beth L Mapow; Michael Styler; Wilbur B Bowne Journal: Case Rep Oncol Med Date: 2017-11-30