Surgical Outcomes of Patients with Gastrointestinal Stromal Tumors in the Era of Targeted Drug Therapy |
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Authors: | Mehrdad Nikfarjam Eric Kimchi Serene Shereef Niraj J Gusani Yixing Jiang John Liang Mandeep Sehmbey Kevin F Staveley-O’Carroll |
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Institution: | (1) Department of Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, H070, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA;(2) Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA;(3) Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA |
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Abstract: | Background The discovery of the c-KIT mutation and the advent of targeted drug therapy with imatinib mesylate have revolutionized the
management of gastrointestinal stromal tumors (GISTs). The outcome of patients with surgically treated GISTs treated in the
era of targeted drug therapy was assessed and factors associated with adverse outcomes determined.
Materials and Methods Patients with GISTs requiring surgery at a tertiary care center from 2002 to 2007 were reviewed and prognostic factors determined.
Results Forty patients were surgically treated for GISTs. The median age at presentation was 59 years. The stomach (55%) was the main
site of primary disease. The median tumor size was 7 cm. Eleven (28%) patients had metastatic disease at presentation. Surgery
was undertaken in all patients with curative intent. Multi-organ resection was required in 10 (25%) patients. Imatinib mesylate
was administered postoperatively in 68% of cases. Median follow-up was 24 months. There was a 40% recurrence rate with 63%
undergoing repeat surgical resection. The peritoneum and liver were the main sites of recurrent disease. The 5-year disease-specific
survival and disease-free survival (DFS) were 65% and 35%, respectively. High mitotic rate (P = 0.017) and tumor size greater than 10 cm (P = 0.009) were the only prognostically significant adverse factors of DFS on multivariate analysis, independent of imatinib
mesylate treatment.
Conclusion Aggressive surgical treatment and follow-up of GISTs, combined with targeted drug therapy, leads to long-term DFS survival.
Tumor recurrence is independently associated with a high tumor mitotic rate and size greater than 10 cm, despite the use of
adjuvant targeted drug therapy. |
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Keywords: | Gastrointestinal stromal tumor Recurrence Disease-free survival Mitotic rate Size Imitinab mesylate Multivisceral resection Targeted therapy |
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