Department of Surgery, Jefferson Medical College, Philadelphia, PA, USA.
Ann Surg Oncol. 2012 Jun;19(6):1748-58. doi: 10.1245/s10434-012-2222-9.
Tyrosine kinase inhibitor (TKI) therapy for patients with gastrointestinal stromal tumors (GISTs) has been shown to improve overall outcomes. It remains unclear whether TKIs are delaying tumor recurrence or actually affecting cure rates. We sought to determine whether changes in overall and disease-specific survival (OS and DSS, respectively) for patients with surgically resected gastric GISTs have been observed after the introduction of TKI therapies by using population-based data.
The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with resected gastric mesenchymal tumors before the introduction of TKIs (pre-TKI: 1990–1994) and after their inception (post-TKI: 2002–2003).
Overall, 594 patients with gastric mesenchymal tumors were identified, and 189 and 405 underwent resection in the pre- and post-TKI eras, respectively. Between groups, there were no significant differences in patient demographics. The 1- and 6-year OS improved from 84 and 36 to 93 and 71%, respectively. The 1- and 6-year DSS improved from 92 and 62 to 96 and 90%, respectively. Through 6 years, OS and DSS significantly improved for all stages, tumor sizes, and extent of operation. By using multivariate analysis, undergoing treatment in the pre-TKI era was an independent negative predictor of OS, hazard ratio (HR, 2.98) and DSS (HR, 3.81).
The TKI era is associated with dramatic improvements in OS and DSS for patients with surgically resected gastric GISTs, irrespective of stage, tumor size, and extent of operation through 6 years of follow-up. It remains unclear, however, whether this survival advantage is a change in cure rate or simply a delay in disease progression.
酪氨酸激酶抑制剂（TKI）治疗胃肠道间质瘤（GIST）患者已被证明可改善总体预后。目前尚不清楚 TKI 是否会延迟肿瘤复发，还是实际上会影响治愈率。我们旨在通过基于人群的数据来确定手术切除的胃 GIST 患者在引入 TKI 治疗后，其总体生存（OS）和疾病特异性生存（DSS）是否发生变化。
在引入 TKI（TKI 前：1990-1994 年）之前和之后，使用监测、流行病学和最终结果（SEER）数据库查询接受胃间质瘤切除术的患者。
总体上，共鉴定出 594 例胃间质瘤患者，分别有 189 例和 405 例患者在 TKI 前和 TKI 后接受了手术切除。两组患者的人口统计学特征无显著差异。1 年和 6 年 OS 分别从 84%和 36%提高到 93%和 71%。1 年和 6 年 DSS 分别从 92%和 62%提高到 96%和 90%。经过 6 年的随访，所有分期、肿瘤大小和手术范围的 OS 和 DSS 均显著改善。通过多变量分析，TKI 前治疗时代是 OS（HR，2.98）和 DSS（HR，3.81）的独立负预测因子。
TKI 时代与手术切除的胃 GIST 患者的 OS 和 DSS 显著改善相关，无论分期、肿瘤大小和手术范围如何，在 6 年的随访中均如此。然而，尚不清楚这种生存优势是治愈率的变化，还是疾病进展的延迟。
