Wang Jian, Yin Yuan, Shen Chaoyong, Yin Xiaonan, Cai Zhaolun, Pu Lin, Fu Wei, Wang Yaxuan, Zhang Bo
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2020 Feb;99(9):e19275. doi: 10.1097/MD.0000000000019275.
The advent of imatinib mesylate (IM) has dramatically revolutionized the prognosis of advanced and metastatic/recurrent gastrointestinal stromal tumors (GISTs). The objective of this retrospective study is to investigate the safety and efficacy of combination of surgery following IM treatment in the management of advanced and metastatic/recurrent GISTs. We further explore the long-term clinical outcomes in these who underwent therapy of preoperative IM.Eligible patients with GISTs before the onset of the IM therapy and were periodically followed up in the outpatient clinic were included in this study. Detailed clinical and pathologic characteristics were obtained from the medical records of our institution. Univariate and multivariate regression analyses were performed to use for the evaluation of potential prognostic factors.A total of 51 patients were included in the study, of these patients, 36 patients underwent surgery and median duration of preoperative IM is 8.2months (range 3.5-85 months). Significant median tumor shrinkage rate was 29.27% (95% confidence interval 21.00%-34.00%) observed in these patients who responded to IM, and partial response and stable disease were achieved in 24 patients (47.06%) and 23 patients (45.10%), respectively, in light of the RECIST guideline (version 1.1). After the median follow-up of 43.70 months (range 14.2-131.1 months), 1- and 3-year overall survival (OS) were estimated to be 96.1% and 94.0%, respectively, and there was a significant improvement in OS for patients who received surgical intervention versus those who did not.Our study consolidates that patients were received preoperative IM therapy could shrink the size of tumors and facilitate organ-function preservation. The long-term analysis on this study supports that surgical intervention following IM therapy benefits for patients with primary advanced and recurrent or metastatic GISTs on long-term prognosis.
甲磺酸伊马替尼（IM）的出现极大地改变了晚期及转移性/复发性胃肠道间质瘤（GIST）的预后。本回顾性研究的目的是探讨IM治疗后联合手术在晚期及转移性/复发性GIST治疗中的安全性和有效性。我们进一步探讨了接受术前IM治疗患者的长期临床结局。本研究纳入了IM治疗开始前符合条件的GIST患者，这些患者在门诊定期随访。从我们机构的病历中获取详细的临床和病理特征。进行单因素和多因素回归分析以评估潜在的预后因素。本研究共纳入51例患者，其中36例患者接受了手术，术前IM的中位持续时间为8.2个月（范围3.5 - 85个月）。在对IM有反应的患者中观察到显著的中位肿瘤缩小率为29.27%（95%置信区间21.00% - 34.00%），根据RECIST指南（1.1版），分别有24例患者（47.06%）达到部分缓解，23例患者（45.10%）病情稳定。中位随访43.70个月（范围14.2 - 131.1个月）后，1年和3年总生存率（OS）分别估计为96.1%和94.0%，接受手术干预的患者与未接受手术干预的患者相比，OS有显著改善。我们的研究证实，接受术前IM治疗的患者可缩小肿瘤大小并有助于保留器官功能。本研究的长期分析支持，IM治疗后进行手术干预对原发性晚期、复发性或转移性GIST患者的长期预后有益。
