The Role of Surgical Resection Following Imatinib Treatment in Patients with Recurrent or Metastatic Gastrointestinal Stromal Tumors: Results of Propensity Score Analyses |
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Authors: | Seong Joon Park MD Min-Hee Ryu MD PhD Baek-Yeol Ryoo MD PhD Young Soo Park MD PhD Byeong Seok Sohn MD PhD Hwa Jung Kim MD PhD Chan Wook Kim MD PhD Ki-Hun Kim MD PhD Chang Sik Yu MD PhD Jeong Hwan Yook MD PhD Byung Sik Kim MD PhD Yoon-Koo Kang MD PhD |
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Institution: | 1. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 3. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract: | Background Although benefits of surgical resection of residual gastrointestinal stromal tumors (GISTs) after imatinib therapy have been suggested, those benefits over imatinib alone have not been proven. We compared the clinical outcomes of surgical resection of residual lesions after imatinib treatment (S group) with imatinib treatment alone (NS group) in patients with recurrent or metastatic GISTs. Methods A total of 134 patients (42 in the S group, 92 in the NS group) with recurrent or metastatic GIST who had stable disease for more than 6 months after responding to imatinib were included. Results There were no statistically significant differences in the baseline characteristics of the S and NS groups except for age and number of peritoneal metastases. The median follow-up period was 58.9 months. Progression-free survival (PFS) and overall survival (OS) were significantly longer in the S group compared with the NS group (median PFS: 87.7 vs. 42.8 months, p = 0.001; median OS: not reached vs. 88.8 months, p = 0.001). Multivariate analysis revealed that S group, female sex, KIT exon 11 mutations, and low initial tumor burden were associated with longer PFS, and S group and low initial tumor burden were associated with a longer OS. Even after applying inverse probability of treatment weighting adjustment, the S group demonstrated significantly better outcomes in terms of PFS (HR 2.326; 95 % confidence interval CI] 1.034–5.236; p = 0.0412) and OS (HR 5.464; 95 % CI 1.460–20.408; p = 0.0117). Conclusion Surgical resection of residual lesions after disease control with imatinib is likely to be beneficial to patients with recurrent or metastatic GISTs. |
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