Qichen Chen1, Cong Li2, Han Yang3, Hong Zhao1, Jianxiong Wu1, Jianjun Zhao1, Xinyu Bi1, Zhiyu Li1, Zhen Huang1, Yefan Zhang1, Jianqiang Cai4, Jianguo Zhou5. 1. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. 2. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 3. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 4. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. caijianqiang@cicams.ac.cn. 5. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. zjgty@hotmail.com.
Abstract
OBJECTIVE: To investigate the differences in the efficacy of hepatic resection combined with tyrosine kinase inhibitor (TKI) therapy versus TKI therapy alone and the timing of the TKI therapy and hepatic resection for resectable liver metastases from gastrointestinal stromal tumours (GISTs). METHODS: This was a retrospective review of 43 patients confirmed to have resectable liver metastases from GISTs who received TKI treatment alone or the therapy model of hepatic resection combined with TKIs and were admitted to one of 3 institutions between January 2006 and December 2017. RESULTS: For all liver metastases patients, the 1-, 3- and 5-year survival rates were 97.67%, 88.98% and 66.46%, respectively. The median overall survival (OS) was 85 months. Patients who underwent hepatic resection combined with TKI therapy had a significantly better OS and a trend towards improved progression-free survival (PFS) than patients who received TKIs alone (P = 0.001, mOS 102 months versus 51 months; P = 0.077, mPFS 42 months versus 30 months). Hepatic resection combined with TKI therapy was the only prognostic factor for long-term survival in the multivariate analysis (HR = 0.198, 95% CI 0.048-0.813, P = 0.025). Compared with patients who underwent hepatic resection combined with postoperative TKIs only, patients who underwent hepatic resection combined with perioperative TKIs had a significantly better PFS (P = 0.032, mPFS 29 months versus 19 months) but did not have a significantly better OS (P = 0.662, mOS 92 months versus 102 months). Resection combined with perioperative TKI therapy was the only prognostic factor for PFS in the multivariate analysis (HR = 0.295, 95% CI 0.101-0.862, P = 0.026). CONCLUSIONS: For patients with resectable liver metastases, hepatic resection combined with TKI therapy was more beneficial in terms of improving prognosis than TKIs alone. In terms of the timing of TKI therapy and hepatic resection, resection combined with perioperative TKIs may prolong PFS more than resection combined with postoperative TKIs only.
OBJECTIVE: To investigate the differences in the efficacy of hepatic resection combined with tyrosine kinase inhibitor (TKI) therapy versus TKI therapy alone and the timing of the TKI therapy and hepatic resection for resectable liver metastases from gastrointestinal stromal tumours (GISTs). METHODS: This was a retrospective review of 43 patients confirmed to have resectable liver metastases from GISTs who received TKI treatment alone or the therapy model of hepatic resection combined with TKIs and were admitted to one of 3 institutions between January 2006 and December 2017. RESULTS: For all liver metastasespatients, the 1-, 3- and 5-year survival rates were 97.67%, 88.98% and 66.46%, respectively. The median overall survival (OS) was 85 months. Patients who underwent hepatic resection combined with TKI therapy had a significantly better OS and a trend towards improved progression-free survival (PFS) than patients who received TKIs alone (P = 0.001, mOS 102 months versus 51 months; P = 0.077, mPFS 42 months versus 30 months). Hepatic resection combined with TKI therapy was the only prognostic factor for long-term survival in the multivariate analysis (HR = 0.198, 95% CI 0.048-0.813, P = 0.025). Compared with patients who underwent hepatic resection combined with postoperative TKIs only, patients who underwent hepatic resection combined with perioperative TKIs had a significantly better PFS (P = 0.032, mPFS 29 months versus 19 months) but did not have a significantly better OS (P = 0.662, mOS 92 months versus 102 months). Resection combined with perioperative TKI therapy was the only prognostic factor for PFS in the multivariate analysis (HR = 0.295, 95% CI 0.101-0.862, P = 0.026). CONCLUSIONS: For patients with resectable liver metastases, hepatic resection combined with TKI therapy was more beneficial in terms of improving prognosis than TKIs alone. In terms of the timing of TKI therapy and hepatic resection, resection combined with perioperative TKIs may prolong PFS more than resection combined with postoperative TKIs only.