Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?
Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?
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DOI：
10.1093/annonc/mdp310
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发表时间：
2010-02-01
影响因子：
50.5
通讯作者：
Gronchi, A.
中科院分区：
文献类型：
--
作者：
Mussi, C.;Ronellenfitsch, U.;Gronchi, A.
背景：伊马替尼治疗转移性胃肠道间质瘤（GIST）的手术指征尚未确定。材料和方法：我们分析了从2002年7月到2007年10月接受伊马替尼治疗后手术转移性GIST的80例患者。患者分为临床反应最佳手术组（A组，n = 49）和局灶性进展手术组（B组，n = 31）。主要终点为无进展生存期（PFS）和疾病特异性生存期（DSS）。结果：A组术后2年PFS为64.4%，B组为9.7% （P < 0.01）。A组未达到中位PFS；B组为8个月。两组患者均未达到伊马替尼起效时的中位DSS。A组5年DSS为82.9%，B组为67.6% （P < 0.01）。多因素分析证实b组的PFS和DSS明显较短，其中13例（16.3%）发生手术。结论：在选定的病例中，局灶性进展性病变的手术可以考虑作为二线/三线治疗的一部分。与单独使用伊马替尼治疗的同类患者群体的历史对照相比，获得最佳临床反应的残留疾病手术似乎与生存获益相关。然而，需要前瞻性随机试验的证据来提出明确的建议。
Background: Surgical indication for metastatic gastrointestinal stromal tumor (GIST) treated with imatinib is not yet established.Materials and methods: We analyzed 80 patients who underwent surgery for metastatic GIST after imatinib therapy from July 2002 to October 2007. Patients were divided into those with surgery at best clinical response (group A, n = 49) and those with surgery at focal progression (group B, n = 31). Primary end points were progression-free survival (PFS) and disease-specific survival (DSS).Results: Two-year postoperative PFS was 64.4% in group A and 9.7% in group B (P < 0.01). In group A, median PFS was not reached; in group B, it was 8 months. Median DSS from the time of imatinib onset was not reached in either group. Five-year DSS was 82.9% in group A and 67.6% in group B (P < 0.01). Multivariate analysis confirmed a significantly shorter PFS and DSS in group B. Surgical morbidity occurred in 13 patients (16.3%).Conclusions: Surgery for focal progressive lesions could be considered as part of the second-line/third-line armamentarium in selected cases. Surgery of residual disease upon best clinical response seems associated with survival benefit compared with historical controls in similar patient collectives treated with imatinib alone. However, evidence from prospective randomized trials is needed to make definite recommendations.