Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Int J Cancer. 2022 Nov 15;151(10):1770-1777. doi: 10.1002/ijc.34157. Epub 2022 Jun 30.
Three years of adjuvant imatinib is the current standard for patients with high-risk gastrointestinal stromal tumors (GIST). We aimed to investigate the safety and efficacy profiles of 3-year imatinib, focusing on the prognostic value of various factors. In this registry-based study, 222 patients with high-risk GIST who underwent surgical resection followed by 3 years of adjuvant imatinib between 2010 and 2018 were included. The imatinib dose was reduced in 39 (17.6%), and 13 (5.9%) discontinued imatinib due to toxicity. With a median follow-up duration of 65.7 months, 5-year recurrence-free survival (RFS) and overall survival (OS) were 73.2% and 93.9%, respectively. Tumor rupture, tumor size of >10 cm, mitotic index of >10/50 high power fields (HPF) were independent factors for short RFS. Patient subgroups stratified by the risk factors showed distinct RFS (P < .001): patients without the above risk factors or those with only a tumor size of >10 cm showed favorable RFS (5-year RFS 83.8% and 92.3%, respectively), whereas those with tumor rupture or those with tumor size of >10 cm and mitotic index of >10/50 HPF showed prominently poor RFS (5-year RFS of 54.8% and 47.9%, respectively). Three years of adjuvant imatinib treatment was generally tolerable and effective, which were consistent with the clinical outcomes of previous reports. The presence of tumor rupture, large tumor and high mitotic count was independently associated with poor RFS. Based on these risk factors, different management strategies, such as different durations of adjuvant imatinib, deserve further investigation.
三年的伊马替尼辅助治疗是目前高危胃肠道间质瘤（GIST）患者的标准治疗方案。我们旨在研究 3 年伊马替尼的安全性和疗效，重点关注各种因素的预后价值。在这项基于登记的研究中，纳入了 2010 年至 2018 年间接受手术切除后接受 3 年伊马替尼辅助治疗的 222 例高危 GIST 患者。39 例（17.6%）患者减少了伊马替尼剂量，13 例（5.9%）因毒性而停止使用伊马替尼。中位随访时间为 65.7 个月，5 年无复发生存率（RFS）和总生存率（OS）分别为 73.2%和 93.9%。肿瘤破裂、肿瘤大小>10cm、核分裂象>10/50 高倍视野（HPF）是 RFS 较短的独立因素。按危险因素分层的患者亚组显示出明显不同的 RFS（P<0.001）：无上述危险因素或仅有肿瘤大小>10cm 的患者具有良好的 RFS（5 年 RFS 分别为 83.8%和 92.3%），而肿瘤破裂或肿瘤大小>10cm 且核分裂象>10/50 HPF 的患者 RFS 明显较差（5 年 RFS 分别为 54.8%和 47.9%）。3 年的伊马替尼辅助治疗总体上是耐受和有效的，与之前报告的临床结果一致。肿瘤破裂、肿瘤较大和高核分裂象的存在与 RFS 不良独立相关。基于这些危险因素，不同的管理策略，如辅助伊马替尼的不同持续时间，值得进一步研究。
