新辅助酪氨酸激酶抑制剂治疗胃肠道间质瘤后影响肿瘤学结局的预后因素分析
Analysis of prognostic factors impacting oncologic outcomes after neoadjuvant tyrosine kinase inhibitor therapy for gastrointestinal stromal tumors.
作者信息
Bednarski Brian K, Araujo Dejka M, Yi Min, Torres Keila E, Lazar Alexander, Trent Jonathan C, Cormier Janice N, Pisters Peter W T, Lev Dina Chelouche, Pollock Raphael E, Feig Barry W, Hunt Kelly K
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Ann Surg Oncol. 2014 Aug;21(8):2499-505. doi: 10.1245/s10434-014-3632-7. Epub 2014 Mar 18.
BACKGROUND
Management of gastrointestinal stromal tumors (GISTs) has been transformed with tyrosine kinase inhibitors (TKIs). While data on optimal duration of adjuvant imatinib remains elusive, guidelines for administration of neoadjuvant TKIs remain unknown.
METHODS
Under an institutional review board-approved protocol, patients at our institution with a diagnosis of GIST treated with neoadjuvant TKIs and surgical resection were identified. Clinical and pathologic characteristics were obtained from medical records.
RESULTS
Ninety-three patients underwent surgical resection after neoadjuvant TKI therapy; 41 had primary and 52 had recurrent/metastatic GIST. Median follow-up was 2.4 years. Median duration of neoadjuvant therapy was 315 (range 3-1,611) days for primary and 537 (range 4-3,257) days for recurrent/metastatic GIST (p = 0.001). Two-year, recurrence-free survival (RFS) was 85 and 44 % for primary and recurrent/metastatic disease, respectively, whereas 2-year overall survival (OS) was 97 % for primary and 73 % for recurrent/metastatic GIST. For primary GIST, duration of neoadjuvant therapy >365 days (p = 0.02) was associated with higher risk of recurrence on univariate analysis, whereas none of the clinicopathologic factors impacted OS. For recurrent/metastatic disease, disease progression was associated with a shorter OS (p = 0.001), but no factors were found to impact RFS. Lastly, when examining all patients, KIT mutations (p = 0.03) and multivisceral resection (p = 0.011) predicted shorter RFS.
CONCLUSIONS
Neoadjuvant TKIs can be effectively used for the treatment of primary and recurrent/metastatic GIST. While duration of neoadjuvant therapy, KIT mutation status, and the need for multivisceral resection can help to predict higher risk for recurrence, progression on neoadjuvant TKIs can aid in selection of patients with recurrent/metastatic disease for surgical resection.
背景
酪氨酸激酶抑制剂（TKIs）改变了胃肠道间质瘤（GISTs）的治疗方式。虽然辅助性伊马替尼的最佳用药时长数据尚不明确，但新辅助TKIs的给药指南仍不清楚。
方法
在一项经机构审查委员会批准的方案下，我们机构中接受新辅助TKIs治疗并进行手术切除的GIST确诊患者被纳入研究。从病历中获取临床和病理特征。
结果
93例患者在新辅助TKI治疗后接受了手术切除；41例为原发性GIST，52例为复发/转移性GIST。中位随访时间为2.4年。原发性GIST新辅助治疗的中位时长为315天（范围3-1611天），复发/转移性GIST为537天（范围4-3257天）（p = 0.001）。原发性和复发/转移性疾病的两年无复发生存率（RFS）分别为85%和44%，而原发性和复发/转移性GIST的两年总生存率（OS）分别为97%和73%。对于原发性GIST，单因素分析显示新辅助治疗时长>365天（p = 0.02）与复发风险较高相关，而没有任何临床病理因素影响总生存率。对于复发/转移性疾病，疾病进展与较短的总生存率相关（p = 0.001），但未发现影响无复发生存率的因素。最后，在检查所有患者时，KIT突变（p = 0.03）和多脏器切除（p = 0.011）预示着较短的无复发生存期。
结论
新辅助TKIs可有效用于治疗原发性和复发/转移性GIST。虽然新辅助治疗时长、KIT突变状态以及多脏器切除的需求有助于预测较高的复发风险，但新辅助TKIs治疗期间的疾病进展有助于选择适合手术切除的复发/转移性疾病患者。
Zotero 插件