Hepatic metastases in gastrointestinal stromal tumors: oncologic outcomes with curative-intent hepatectomy, resection of treatment-resistant disease, and tyrosine kinase inhibitor therapy alone
Hepatic metastases in gastrointestinal stromal tumors: oncologic outcomes with curative-intent hepatectomy, resection of treatment-resistant disease, and tyrosine kinase inhibitor therapy alone
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DOI：
10.1016/j.hpb.2021.11.011
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发表时间：
2022-05-30
期刊：
影响因子：
2.9
通讯作者：
Mayo, Skye C.
中科院分区：
文献类型：
--
作者：
Sutton, Thomas L.;Walker, Brett S.;Mayo, Skye C.
背景：转移性GIST （mGIST）的肝切除术通常是为了治疗目的或对酪氨酸激酶抑制剂（TKI）耐药的病变进行的。肝切除术治疗顽固性病变（TRL）的疗效尚不确定。方法：回顾性分析2003年至2018年肝脏mgist患者的治疗情况。肿瘤预后包括总体（OS）、术后无进展生存（PFS）和进展后OS，采用Kaplan-Meier和Cox比例风险模型进行评估。结果：我们确定了n = 91例患者；31例（34%）患者接受了治愈性肝切除术，60例（66%）患者最初仅接受TKI治疗，17例（19%）患者接受了TRL切除术。切除患者的中位随访时间为102个月（5- 209个月），其中23例（25%）患者行肝切除术。在诊断为肝- mgist后，接受治疗目的肝切除术的患者的10年总生存率为72%，而TRL切除术的患者为58% (P = 0.50)，未切除的患者为41% （P = 0.01）。治疗目的肝切除术（HR 0.39, P = 0.03）和年龄（HR 1.04, P = 0.004）与10年OS独立相关，但与TRL切除术无关。与二线TKI治疗相比，TRL切除术与进展后OS改善无关（HR 0.61, P = 0.21）。结论：以治疗为目的的肝切除术与肝- mgist的OS改善相关。在多线TKI治疗时代，切除耐药肝- mgist与单独二线TKI治疗相比的肿瘤学益处尚不清楚。
Background: Hepatic resection for metastatic GIST (mGIST) is often performed with either curativeintent or for tyrosine kinase inhibitor (TKI)-resistant lesions. The efficacy of hepatectomy for treatmentresistant lesions (TRL) is uncertain.Methods: We reviewed patients with liver-mGIST treated from 2003 to 2018. Oncologic outcomes including overall (OS), post-operative progression-free survival (PFS), and post-progression OS were evaluated using Kaplan-Meier and Cox proportional hazards modeling.Results: We identified n = 91 patients; 31 (34%) underwent curative-intent hepatectomy, 60 (66%) were initially managed with TKI alone, and 17 (19%) had resection of a TRL. The median follow-up for resected patients was 102 months (range 5- 209 months) with 23 (25%) managed with a major hepatectomy. Patients having curative-intent hepatectomy had 72% 10-year OS following diagnosis of liver-mGIST, compared with 58% (P = 0.50) for TRL resection and 41% (P = 0.01) for non-resected patients. Curative-intent hepatectomy (HR 0.39, P = 0.03) and age (HR 1.04, P = 0.004) were independently associated with 10-year OS, but not TRL resection. TRL resection was not associated with improved post-progression OS compared to second-line TKI therapy (HR 0.61, P = 0.21).Conclusions: Curative-intent hepatectomy is associated with improved OS in liver-mGIST. The oncologic benefit of resecting treatment-resistant liver-mGIST compared to second-line TKI therapy alone remains unclear in the era of multi-line TKI therapy.