Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi-center cohort study |
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| Institution: | 1. Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangdong, China;2. Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China;3. General Surgery, The General Hospital of the People''s Liberation Army, Beijing, China;4. Department of Gastrointestinal Surgery, Shanghai Changhai Hospital, Navy Military Medical University, Shanghai, China;5. Gastrointestinal Surgery, West China Hospital, Sichuan University, Sichuan, China;6. Department of Gastric Surgery, Union Hospital of Fujian Medical University, Fujian, China;7. Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China;8. Department of Oncology, The Affiliated Hospital of Qingdao University, Shandong, China;9. People''s Liberation Army Cancer Center, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China;10. Department of Gastrointestinal and Nutriology Surgery, Shengjing Hospital of China Medical University, Liaoning, China;11. Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Liaoning, China;12. Department of Hepatobiliary Surgery, National Cancer Center/cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;13. Department of Hepatobiliary Surgery, Laboratory of Carcinogenesis and Translational Research of the Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China;14. Department of GI Oncology, Laboratory of Carcinogenesis and Translational Research of the Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China;1. Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA;2. Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic;3. Chiba Cancer Center, Urology, Chiba, Japan;4. Hannover Medical School, Hannover, Germany;5. H Lee Moffitt Cancer Center, Tampa, FL, USA;6. Hospital General Universitario Gregorio Marañón, Madrid, Spain;7. Pfizer Oncology, San Diego, CA, USA;8. Pfizer Inc, New York, NY, USA;9. The University of Texas M D Anderson Cancer Center, Houston, TX, USA;1. APHP GHU Avicenne, Bobigny, France;2. Universite Paris Nord, UFR SMBH Bobigny, France;1. Department of Gastroenterology and Digestive Oncology, CHU Avicenne, APHP, Bobigny, France;2. Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, U1071 INSERM, Clermont-Auvergne University, Clermont-Ferrand, France;3. Department of Gastroenterology and Digestive Oncology, CHU Saint Louis, APHP, Denis Diderot University, Sorbonne Paris Cité, Paris, France;4. Department of Gastroenterology, CHU Cochin, APHP, Paris, France;5. Department of Gastroenterology, CHU Henri Mondor, APHP, Créteil, France;6. Department of Hepato-Gastroenterology and Digestive Oncology, Trousseau Hospital, CHU Tours, Tours, France;7. Department of Oncology, CHU Saint-Antoine, APHP, Paris, France;8. Department of Digestive Oncology, CHU Georges Pompidou, APHP, Paris, France;9. Department of Digestive Surgery, CHU Lariboisière, APHP, Paris, France;10. Sorbonne University, UPMC, Department of Hepato-Gastroenterology, CHU Pitiè-Salpétrière, APH, Paris, France;11. Department of Oncology and Radiotherapy, Clinic Tivoli, Bordeaux, France;12. Department of Gastroenterology, CHU Robert Debré, Reims, France;13. Department of Surgery, Grenoble University Hospital, Grenoble, France;14. Department of Gastroenterology, CHU Edouard Herriot, HCL, Lyon, France;15. Department of Gastroenterology, Polyclinic Bordeaux Nord, Bordeaux, France;p. Department of Gastroenterology, CHU Dijon, University of Bourgogne-Franche Comté, INSERM U1231, Dijon, France;q. Department of Gastroenterology, CHU Poitiers, Poitiers, France;r. Department of Gastroenterology, CHU Haut-Lévêque, Pessac, France;s. Department of Oncology, Saint Quentin Hospital, Saint Quentin, France;t. Department of Oncology, Auxerre Hospital, Auxerre, France;u. Department of Oncology, Castres Hospital, Castres, France;v. Department of Hepato-Gastroenterology and Digestive Oncology, CHR La Source, Orléans, France |
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| Abstract: | BackgroundThe progression-free survival (PFS) is not optimal when imatinib was recommended for treatment of gastrointestinal stromal tumor (GIST) undergoing surgery after tumor local or multifocal progression.MethodsWe evaluate PFS of patients undergoing R0 resection or optimal cytoreductive surgery followed by sunitinib therapy compared with imatinib after tumor unifocal or multifocal progression.ResultsFrom January 2006 to June 2017, ninety-seven patients from thirteen medical centers were enrolled. Fifty-six patients continued imatinib therapy and 41 patients switched sunitinib treatment directly after R0 resection or optimal cytoreductive surgery. The PFS of sunitinib group was longer than that of imatinib group (30.0 months vs 12.0 months, p = 0.009). In subgroup analysis, the PFS of the sunitinib and imatinib groups were 25.5 months and 12.0 months in patients with tumor multifocal progression (p = 0.008), and 39.0 months and 13.0 months in patients with unifocal progression (p = 0.156), respectively. PFS of postoperative sunitinib group was also superior to the total PFS of postoperative imatinib group (PFS of postoperative imatinib plus PFS of subsequent sunitinib therapy (30.0 months vs 21.0 months, p = 0.012). The overall survival in the sunitinib and imatinib groups were 37.0 months and 33.0 months, respectively (p = 0.794).ConclusionsSurgery followed by sunitinib in GIST patients with unifocal or multifocal progression on imatinib may improve PFS, compared with surgery followed by imatinib. |
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| Keywords: | Gastrointestinal stromal tumor Tumor progression Cytoreductive surgery Sunitinib |
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