Yeh Chun-Nan, Hu Chia-Hsiang, Wang Shang-Yu, Wu Chiao-En, Chen Jen-Shi, Tsai Chun-Yi, Hsu Jun-Te, Yeh Ta-Sen
GIST Team, Department of Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University, Taiwan.
GIST Team, Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou; Chang Gung University, Taiwan.
J Cancer. 2021 Apr 12;12(11):3335-3343. doi: 10.7150/jca.50324. eCollection 2021.
Current evidence have shown surgery may provide progression-free survival (PFS) benefit for selected patients with metastatic gastrointestinal stromal tumor (GIST) who received first line imatinib and second line sunitinib. However, impact of cytoreductive surgery for GIST patients receiving third line regorafenib facing progression is not yet reported. Between 2014 and 2019, 41 patients with metastatic GIST received regorafenib and 37 of them facing progression. 37 of 41 (90.2%) pre-treated GIST patients receiving regorafenib who experienced progression of disease after a median follow-up of 12.42 months after regorafenib use and 15 out of 37 (40.5%) patients with local progression underwent cytoreductive surgery (local progression and operation, LPOP). All the patients facing local progression (LP) were significantly younger with more exon 17 mutation than diffuse progression (DP). The complication rate for cytoreductive surgery was 33.3% (5/15). Cytoreductive surgery provided PFS prolongation of 5.52 months. Patients underwent cytoreductive surgery, compared with control group (local progression and no operation (LPNOP) and DP), may gain a significant PFS (12.91 versus 2.33 versus 5.29 months, = 0.0001) and overall survival (OS) benefit (32.33 versus 5.26 versus 12.42 months, = 0.004). Cytoreductive surgery might be feasible in highly selected patients with pre-treated GIST who are being treated with regorafenib experiencing LP.
目前的证据表明，手术可能会为接受一线伊马替尼和二线舒尼替尼治疗的特定转移性胃肠道间质瘤（GIST）患者带来无进展生存期（PFS）获益。然而，对于接受三线瑞戈非尼治疗且病情进展的GIST患者，减瘤手术的影响尚未见报道。2014年至2019年期间，41例转移性GIST患者接受了瑞戈非尼治疗，其中37例病情进展。41例接受瑞戈非尼预处理的GIST患者中，37例（90.2%）在使用瑞戈非尼后中位随访12.42个月出现疾病进展，37例局部进展患者中有15例（40.5%）接受了减瘤手术（局部进展并手术，LPOP）。所有面临局部进展（LP）的患者均比弥漫性进展（DP）患者明显年轻，外显子17突变更多。减瘤手术的并发症发生率为33.3%（5/15）。减瘤手术使PFS延长了5.52个月。与对照组（局部进展未手术（LPNOP）和DP）相比，接受减瘤手术的患者可能获得显著的PFS（12.91个月对2.33个月对5.29个月，P = 0.0001）和总生存期（OS）获益（32.33个月对5.26个月对12.42个月，P = 0.004）。对于高度选择的、接受瑞戈非尼治疗且出现LP的预处理GIST患者，减瘤手术可能是可行的。
