Li Weihao, Li Xinyue, Yu Kun, Xiao Binyi, Peng Jianhong, Zhang Rongxin, Zhang Lingfang, Wang Kun, Pan Zhizhong, Li Cong, Wu Xiaojun
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Colorectal Cancer Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Pharmacol. 2022 Sep 27;13:950101. doi: 10.3389/fphar.2022.950101. eCollection 2022.
Several issues on neoadjuvant imatinib therapy remain controversial despite its widespread application for rectal gastrointestinal stromal tumors (GIST). We aimed to describe the clinicopathological characteristics of this specific population, and compare the surgical and oncologic outcomes between patients with or without neoadjuvant imatinib therapy. A cohort of 58 consecutive locally advanced rectal GIST patients receiving surgical treatment between January 2007 and July 2019 at Sun Yat-sen University Cancer Center and Yunnan Cancer Hospital was retrospectively analyzed. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. There were 33 (56.9%) patients who received neoadjuvant imatinib therapy. Among them, 20 (60.6%) patients had partial response (PR) as their best response, 11 (33.3%) patients had stable disease (SD), and 2 (6.1%) patients had progressive disease (PD). The median tumor size reduced from 5.2 to 4.0 cm after treatment ( < 0.001), and an attained "maximal response" was primarily achieved (32/33) on the 12th month after treatment. The most common adverse event was anemia. There were 27 adverse events occurred, most of which were grade 1 (19/27). With respect to intraoperative and postoperative surgical outcomes, no significant difference was found between patients with or without neoadjuvant Imatinib therapy except that patients with neoadjuvant treatment had a significant higher rate of preventive ileostomy ( = 0.004). Patients received neoadjuvant treatment had a superior 2-years RFS outcome than those without, though the difference was no significant (91.7% vs. 78.9%, = 0.203). There were no significant differences in the 2-years OS rates (95.2% vs. 91.3%, = 0.441). Neoadjuvant imatinib therapy is an effective and safe treatment for locally advanced rectal GISTs. Further studies are warranted to validate the long-term prognostic benefit for patients with rectal GISTs receiving neoadjuvant imatinib therapy.
尽管新辅助伊马替尼疗法在直肠胃肠道间质瘤（GIST）中已广泛应用，但关于该疗法仍存在几个有争议的问题。我们旨在描述这一特定人群的临床病理特征，并比较接受或未接受新辅助伊马替尼治疗的患者之间的手术和肿瘤学结局。回顾性分析了2007年1月至2019年7月在中山大学肿瘤防治中心和云南省肿瘤医院接受手术治疗的58例连续的局部晚期直肠GIST患者队列。采用Kaplan-Meier法估计无复发生存期（RFS）和总生存期（OS）。有33例（56.9%）患者接受了新辅助伊马替尼治疗。其中，20例（60.6%）患者最佳反应为部分缓解（PR），11例（33.3%）患者疾病稳定（SD），2例（6.1%）患者疾病进展（PD）。治疗后肿瘤中位大小从5.2 cm降至4.0 cm（<0.001）, 并且主要在治疗后第12个月达到“最大反应”（32/33）。最常见的不良事件是贫血。共发生27例不良事件，其中大多数为1级（19/27）。关于术中和术后手术结局，接受或未接受新辅助伊马替尼治疗的患者之间未发现显著差异，只是接受新辅助治疗的患者预防性回肠造口术发生率显著更高（P = 0.004）。接受新辅助治疗的患者2年RFS结局优于未接受新辅助治疗的患者，尽管差异无统计学意义（91.7% 对78.9%，P = 0.203）。2年OS率无显著差异（95.2% 对91.3%，P = 0.441）。新辅助伊马替尼疗法是局部晚期直肠GIST的一种有效且安全的治疗方法。有必要进一步研究以验证接受新辅助伊马替尼治疗的直肠GIST患者的长期预后获益。
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