Park Seong Joon, Ryu Min-Hee, Ryoo Baek-Yeol, Park Young Soo, Sohn Byeong Seok, Kim Hwa Jung, Kim Chan Wook, Kim Ki-Hun, Yu Chang Sik, Yook Jeong Hwan, Kim Byung Sik, Kang Yoon-Koo
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2014 Dec;21(13):4211-7. doi: 10.1245/s10434-014-3866-4. Epub 2014 Jul 1.
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.
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.
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).
Surgical resection of residual lesions after disease control with imatinib is likely to be beneficial to patients with recurrent or metastatic GISTs.
尽管有研究表明伊马替尼治疗后手术切除残留胃肠道间质瘤（GIST）有一定益处，但与单纯使用伊马替尼相比，这些益处尚未得到证实。我们比较了复发或转移性GIST患者在伊马替尼治疗后手术切除残留病灶（S组）与单纯伊马替尼治疗（NS组）的临床结局。
共有134例复发或转移性GIST患者纳入研究，这些患者在接受伊马替尼治疗后病情稳定超过6个月（S组42例，NS组92例）。
除年龄和腹膜转移灶数量外，S组和NS组的基线特征无统计学显著差异。中位随访期为58.9个月。与NS组相比，S组的无进展生存期（PFS）和总生存期（OS）显著更长（中位PFS：87.7个月对42.8个月，p = 0.001；中位OS：未达到对88.8个月，p = 0.001）。多因素分析显示，S组、女性、KIT外显子11突变和较低的初始肿瘤负荷与更长的PFS相关，S组和较低的初始肿瘤负荷与更长的OS相关。即使应用治疗权重逆概率调整后，S组在PFS（HR 2.326；95%置信区间[CI] 1.034 - 5.236；p = 0.0412）和OS（HR 5.464；95% CI 1.460 - 20.408；p = 0.0117）方面仍显示出显著更好的结局。
伊马替尼控制病情后手术切除残留病灶可能对复发或转移性GIST患者有益。
