Gaitanidis Apostolos, Alevizakos Michail, Tsaroucha Alexandra, Pitiakoudis Michail
Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Gastrointest Cancer. 2019 Dec;50(4):750-758. doi: 10.1007/s12029-018-0137-9.
Primary tumor location has been identified as an important prognostic factor among patients with gastrointestinal stromal tumors (GISTs). The purpose of this study is to identify how primary tumor location may affect outcomes after resection for patients with metastatic GISTs.
Patients with GISTs and distant metastases at diagnosis were identified in the Surveillance Epidemiology and End Results (SEER) database. Patients that underwent surgery were matched to patients that did not undergo surgery using propensity score matching (PSM) analysis.
After PSM, 570 patients were identified (males 334 [58.6%], females 236 [41.4%], age 62 ± 13.9 years). Gastric tumors constituted the majority (325 [57%]), followed by small intestinal (136 [23.9%]), colorectal (19 [3.3%]), and retroperitoneal/peritoneal tumors (23 [4%]). Median follow-up was 25.5 months (95% CI 23-29 months). Undergoing surgery was associated with improved disease-specific survival (DSS) on both univariate (median not reached vs. 51 months, p < 0.001) and multivariate analyses (HR 4.98, 95% CI 2.23-11.12, p < 0.001). A sub-analysis of patients with gastric GISTs showed that undergoing surgery was the only significant factor associated with improved DSS (median not reached vs. 39 months, p < 0.001, HR 2.95, 95% CI 1.92-4.53). In contrast, undergoing surgery was not associated with improved survival for small intestinal, colorectal, or retroperitoneal/peritoneal tumors.
Surgery for gastric metastatic GISTs is associated with improved survival. No discernible benefit after surgical resection was identified for patients with small intestinal, colorectal, retroperitoneal, or peritoneal metastatic GISTs.
原发性肿瘤位置已被确定为胃肠道间质瘤（GIST）患者的一个重要预后因素。本研究的目的是确定原发性肿瘤位置如何影响转移性GIST患者切除术后的结局。
在监测、流行病学和最终结果（SEER）数据库中识别出诊断时患有GIST和远处转移的患者。使用倾向评分匹配（PSM）分析将接受手术的患者与未接受手术的患者进行匹配。
PSM后，共识别出570例患者（男性334例[58.6%]，女性236例[41.4%]，年龄62±13.9岁）。胃肿瘤占大多数（325例[57%]），其次是小肠（136例[23.9%]）、结肠直肠（19例[3.3%]）和腹膜后/腹膜肿瘤（23例[4%]）。中位随访时间为25.5个月（95%CI 23 - 29个月）。在单因素分析（中位生存期未达到 vs. 51个月，p < 0.001）和多因素分析（HR 4.98，95%CI 2.23 - 11.12，p < 0.001）中，接受手术均与疾病特异性生存（DSS）改善相关。对胃GIST患者的亚组分析显示，接受手术是与DSS改善相关的唯一显著因素（中位生存期未达到 vs. 39个月，p < 0.001，HR 2.95，95%CI 1.92 - 4.53）。相比之下，接受手术与小肠、结肠直肠或腹膜后/腹膜肿瘤患者的生存改善无关。
胃转移性GIST手术与生存改善相关。对于小肠、结肠直肠、腹膜后或腹膜转移性GIST患者，未发现手术切除后有明显益处。
