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Eur J Surg Oncol. 2014 Apr;40(4):412-9. doi: 10.1016/j.ejso.2013.12.020. Epub 2014 Jan 15.

Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib -- analysis of prognostic factors (EORTC-STBSG collaborative study).

Author information

1
Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany. Electronic address: sebastian.bauer@uk-essen.de.
2
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland.
3
Department of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany.
4
Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
5
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
6
Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
7
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
8
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
9
Department of General, Liver and Transplant Surgery, Medical University of Warsaw, Poland.
10
Department of General, Visceral and Transplantion Surgery, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
11
Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.

Abstract

BACKGROUND:

Long-term complete remissions remain a rare exception in patients with metastatic gastrointestinal stromal tumors (GIST) treated with IM (imatinib). To date the therapeutic relevance of surgical resection of metastatic disease remains unknown except for the use in palliative intent.

PATIENTS AND METHODS:

We analyzed overall survival (OS) and progression-free survival (PFS) in consecutive patients with metastatic GIST who underwent metastasectomy and received IM therapy (n = 239).

RESULTS:

Complete resection (R0+R1) was achieved in 177 patients. Median OS was 8.7 y for R0/R1 and 5.3 y in pts with R2 resection (p = 0.0001). In the group who were in remission at time of resection median OS was not reached in the R0/R1 surgery and 5.1 y in the R2-surgery (p = 0.0001). Median time to relapse/progression after resection of residual disease was not reached in the R0/R1 and 1.9 years in the R2 group of patients, who were resected in response. No difference in mPFS was seen in patients progressing at time of surgery.

CONCLUSIONS:

Our analysis implicates possible long-term survival in patients in whom surgical complete remission can be achieved. Incomplete resection, including debulking surgery does not seem to prolong survival. Despite the retrospective character and likely selection bias, this analysis may help in decision making for surgical approaches in metastatic GIST.

KEYWORDS:

Gastrointestinal stromal tumor; Imatinib; Metastatic disease; Surgery; Survival

PMID:
24491288
DOI:
10.1016/j.ejso.2013.12.020
[Indexed for MEDLINE]

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