1
|
Wen H, Huang Y, Huang S, Xiao H, Xie W, Zhou Q, Tan L, Ding Y, Liu X, Yu Y, Song Z, Shen S, Chen Z, Zhang X. The long-term efficacy of imatinib with hepatic resection or other local treatment for gastrointestinal stromal tumours liver metastases:a retrospective cohort study. Int J Surg 2024; 110:01279778-990000000-00971. [PMID: 38619177 PMCID: PMC11020002 DOI: 10.1097/js9.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND The liver is the most common site of metastasis from gastrointestinal stromal tumours (GISTs). We aimed to evaluate imatinib (IM) combined with hepatic resection (HR) or other local treatments such as radiofrequency ablation (RFA) and transarterial chemoembolization (TACE), compared to IM monotherapy in long-term survival benefits in patients suffering from GIST liver metastases. METHODS Our research encompassed 238 patients diagnosed with liver metastases of GISTs from January 2002 to April 2022 at the XXX Hospital of XXX University. The oncological outcomes of concern included overall survival (OS), progression-free survival (PFS) and liver-specific PFS. RESULTS Of all 238 patients, 126 were treated with IM alone (IM group), 81 with IM combined with HR (IM+HR group), and 31 with IM combined with RFA/TACE (IM+RFA/TACE group). The median follow-up time was 44.83 months. The median OS in the IM group was 132.60 months and was not reached in either the IM+HR group or the IM+RFA/TACE group. The 10-year OS rate in the IM+HR group was significantly superior to the IM group and the IM+RFA/TACE group (91.9% vs. 61.1% vs. 55.2%, respectively, P=0.015), and the liver-specific PFS (P=0.642) and PFS (P=0.369) in the three groups showed a beneficial trend in the combined treatment group. Multivariate analyses showed that age ≤60 years (HR 0.280, P<0.001) and IM+HR (HR 0.361, P=0.047) were independently associated with better OS. Achieving no evidence of disease (NED) through surgical intervention was independently correlated with enhanced OS (HR 0.099, P=0.034), liver-specific PFS (HR 0.388, P=0.014), and PFS (HR 0.402, P=0.004). CONCLUSIONS In patients with GIST liver metastases, IM combined with HR might improve OS in selected patients compared with IM alone and IM combined with RFA/TACE. Achieving NED status with surgical treatment of patients results in significant prolonging of OS, liver-specific PFS and PFS.
Collapse
Affiliation(s)
| | - Yihao Huang
- Center of Hepato-Pancreatico-Biliary Surgery
| | | | - Han Xiao
- Division of Interventional Ultrasound
| | - Wenxuan Xie
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit
| | - Li Tan
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Yuqi Ding
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaofei Liu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yang Yu
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Zimin Song
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Shunli Shen
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Zebin Chen
- Center of Hepato-Pancreatico-Biliary Surgery
| | | |
Collapse
|
2
|
Liu L, Wang B, Zhang ZY, Wang S, Wu H, Wang H, Wu W, Yan K, Yang W. Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastases from gastrointestinal stromal tumors. Int J Hyperthermia 2023; 41:2292950. [PMID: 38159558 DOI: 10.1080/02656736.2023.2292950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES This study aimed to analyze the survival outcomes and prognostic factors of radiofrequency ablation (RFA) for liver metastases from gastrointestinal stromal tumors (GISTs). METHODS Between March 2011 and November 2022, 34 patients (16 males; age range, 25-72 [median age, 52.5] years) who underwent RFA for liver metastasis from GISTs were included. The mean maximum diameter of metastatic lesions was 2.4 ± 1.0 (range, 1.1-5.2) cm. Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using a Cox proportional hazards model. RESULTS For 79 lesions among 34 patients, all targeted lesions were completely ablated. The mean hepatic progression-free survival (HPFS) period was 28.4 ± 3.8 (range, 1.0-45.7) months. The 1-, 3-, and 5-year HPFS rates were 67.2%, 60.5%, and 20.2%, respectively. Based on the univariate analysis, the number of metastatic tumors and tyrosine kinase inhibitors(TKI) therapy before RFA were prognostic factors for HPFS. Multivariate analysis showed that pre-RFA TKI therapy was associated with a better HPFS(p = 0.030). The mean overall survival (OS) period was 100.5 ± 14.1 (range, 3.8-159.5) months and the 1-, 3-, and 5-year survival rates were 96.9%, 77.1%, and 58.7%, respectively. Both univariate and multivariate analysis indicated that extrahepatic metastasis before RFA (p = 0.044) was a significant prognostic factor for OS. CONCLUSIONS Liver metastases from GIST exhibit relatively mild biological behavior. RFA is safe and effective, particularly in patients without pre-RFA extrahepatic metastases. Patients received targeted therapy before RFA can obtain an extended HPFS.
Collapse
Affiliation(s)
- Li Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| |
Collapse
|
3
|
Rahimi-Ardabily A, Murdande S, Dong M, Gu KW, Zhang B, Miller K, Aploks K, Da Dong X. Liver resection for metastatic GIST tumor improves survival in the era of tyrosine kinase inhibitors: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:373. [PMID: 37740754 DOI: 10.1007/s00423-023-03052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/08/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Survival for gastrointestinal stromal tumor (GIST) has been increasing over the years after the introduction of tyrosine kinase inhibitors. However, the role of metastasectomy for GIST is still controversial. Patients are currently treated with imatinib or sunitinib in case of imatinib failures as optimal medical therapy for metastatic GIST. METHODS The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall survival following liver resection ± tyrosine kinase inhibitor treatment for metastatic GIST was compared to treatment with tyrosine kinase inhibitors alone. RESULTS Eleven studies including both randomized control trials and retrospective cohort studies were included in the final analysis with a total of 988 patients. Seven studies encompassed data on 556 patients with isolated liver metastases (219 surgery ± drug groups and 337 drug-only groups) were included. Overall survival was significantly improved in patients undergoing liver resection ± drug therapy in comparison to drug therapy alone. [HR (95%CI) = 2.10 (1.58, 2.79); p<0.00001]. Subgroup analysis showed that patients also had improved progression free survival based on 4 studies. [HR (95%CI) = 1.92 (1.43, 2.56); p<0.00001]. In case of concurrent liver and peritoneal metastases, patients showed improved overall survival with aggressive surgical approaches based on 10 studies. [HR (95%CI) = 1.90 (1.56, 2.31); p<0.00001]. CONCLUSION This meta-analysis found that liver resection for patients with metastatic GIST regardless of peritoneal metastases improved progression free and overall survival in conjunction with tyrosine kinase inhibitors as compared with medical therapy alone. Furthermore, liver resections did not have any immediate detrimental impact on survival in the group of patients selected.
Collapse
Affiliation(s)
- Arash Rahimi-Ardabily
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Sanjana Murdande
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Michael Dong
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Katie W Gu
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Brianna Zhang
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Kendall Miller
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Krist Aploks
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Xiang Da Dong
- Division of Surgical Oncology, Department of Surgery, Nuvance Health, Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA.
| |
Collapse
|
4
|
Sutton TL, Walker BS, Billingsley KG, Corless CL, Sheppard BC, Heinrich MC, Mayo SC. Ten-Year Survivorship in Patients with Metastatic Gastrointestinal Stromal Tumors. Ann Surg Oncol 2022; 29:7123-7132. [PMID: 35829795 PMCID: PMC10038195 DOI: 10.1245/s10434-022-12063-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients developing metastatic gastrointestinal stromal tumors (mGIST) have heterogenous disease biology and oncologic outcomes; prognostic factors are incompletely characterized. We sought to evaluate predictors of 10-year metastatic survivorship in the era of tyrosine kinase inhibitor (TKI) therapy. METHODS We reviewed patients with mGIST treated at our Comprehensive Cancer Center from 2003 to 2019, including only patients with either mortality or 10 years of follow-up. Ten-year survivorship was evaluated with logistic regression. RESULTS We identified 109 patients with a median age of 57 years at mGIST diagnosis. Synchronous disease was present in 57% (n = 62) of patients; liver (n = 48, 44%), peritoneum (n = 40, 37%), and liver + peritoneum (n = 18, 17%) were the most common sites. Forty-six (42%) patients were 10-year mGIST survivors. Following mGIST diagnosis, radiographic progression occurred within 2 years in 53% (n = 58) of patients, 2-5 years in 16% (n = 17), and 5-10 years in 16% (n = 17), with median survival of 32, 76, and 173 months, respectively. Seventeen (16%) patients had not progressed by 10 years. Fifty-two (47%) patients underwent metastasectomy, which was associated with improved progression-free survival (hazard ratio 0.63, p = 0.04). In patients experiencing progression, factors independently associated with 10-year survivorship were age (odds ratio [OR] 0.96, p = 0.03) and time to progression (OR 1.71/year, p < 0.001). CONCLUSIONS Ten-year survivorship is achievable in mGIST in the era of TKIs and is associated with younger age and longer time to first progression, while metastasectomy is associated with longer time to first progression. The role of metastasectomy in the management of patients with disease progression receiving TKI therapy merits further study.
Collapse
Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Division of General Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Brett S Walker
- Department of Surgery, Division of General Surgery, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Brett C Sheppard
- Department of Surgery, Division of General Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Michael C Heinrich
- Department of Medicine, Division of Hematology/Oncology, Portland VA Health Care System and Oregon Health & Science University, Knight Cancer Institute, Portland, OR, USA
| | - Skye C Mayo
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, OR, USA.
| |
Collapse
|