Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Ann Surg Oncol. 2021 Nov;28(12):7912-7920. doi: 10.1245/s10434-021-10062-6. Epub 2021 May 9.
Gastrointestinal stromal tumors (GIST) commonly recur following curative-intent resection. Patients with recurrent GIST display heterogeneous outcomes with limited prognostic tools. We investigated factors associated with post-recurrence survival (PRS) and progression-free survival (PFS).
We performed a review of our institutional cancer registry from 2003 to 2018 for patients with GIST. Clinicopathologic and outcome data were collected. The disease-free interval (DFI) was calculated from the end of curative-intent oncologic therapy until recurrence. Outcomes were evaluated using Kaplan-Meier and Cox proportional hazards modeling.
Overall, 254 patients underwent resection of primary, non-metastatic GIST, with 81 (32%) recurrences. The median age was 58 years and more than half of the patients with recurrence (n = 44; 54%) received adjuvant imatinib. Recurrence was most common in the liver (n = 34, 42%), peritoneum (n = 31, 38%), or liver plus peritoneum (n = 10, 12%). The median DFI was 14 months (interquartile range 2-26 months); 51 (63%) patients had a DFI ≤24 months and 30 (37%) had a DFI > 24 months. The median post-recurrence follow-up was 46 months. Compared with a DFI ≤24 months, patients with a DFI >24 months had increased 10-year PRS (77% vs. 41%, p < 0.05) and 10-year PFS (73% vs. 19%, p < 0.001). On multivariable analysis controlling for mutational and clinicopathologic features, a DFI >24 months was independently associated with increased PRS (hazard ratio [HR] 0.24, p < 0.01) and PFS (HR 0.18, p < 0.001).
The DFI is independently associated with oncologic outcomes in recurrent GIST and may be useful in treatment planning. Recurrence after 24 months may signify indolent disease biology that may benefit from additional treatment, including metastasectomy.
胃肠道间质瘤（GIST）在根治性切除术后常复发。复发性 GIST 患者的预后结果存在异质性，且预后工具有限。我们研究了与复发后生存（PRS）和无进展生存（PFS）相关的因素。
我们对 2003 年至 2018 年我院癌症登记处的患者进行了回顾性分析，收集了临床病理和结局数据。无病间隔（DFI）是从根治性肿瘤治疗结束到复发的时间。使用 Kaplan-Meier 和 Cox 比例风险模型评估结局。
共有 254 例患者接受了原发性非转移性 GIST 的切除术，其中 81 例（32%）复发。中位年龄为 58 岁，超过一半的复发患者（n=44；54%）接受了辅助伊马替尼治疗。复发最常见的部位是肝脏（n=34，42%）、腹膜（n=31，38%）或肝脏和腹膜（n=10，12%）。中位 DFI 为 14 个月（四分位距 2-26 个月）；51 例（63%）患者的 DFI≤24 个月，30 例（37%）患者的 DFI>24 个月。中位复发后随访时间为 46 个月。与 DFI≤24 个月相比，DFI>24 个月的患者 10 年 PRS（77% vs. 41%，p<0.05）和 10 年 PFS（73% vs. 19%，p<0.001）均显著升高。多变量分析控制了突变和临床病理特征后，DFI>24 个月与 PRS（风险比 [HR]0.24，p<0.01）和 PFS（HR 0.18，p<0.001）的改善独立相关。
DFI 与复发性 GIST 的肿瘤学结局独立相关，可能有助于治疗计划。24 个月后复发可能提示疾病生物学惰性，可能受益于额外的治疗，包括转移灶切除术。
