Gastrointestinal stromal tumor (GIST) with liver metastases

Abstract

Approximately 40% to 50% of gastrointestinal stromal tumor (GIST) patients will have recurrence or metastases after resection of the primary lesion, and the most common affected sites will be liver and peritoneum. Imatinib has been considered as the first-line therapy of metastatic GIST. Surgery for metastases is proposed when possible. Furthermore, there are controversies concerning hepatic resection and systemic tyrosin kinase inhibitors (TKIs). The therapeutic conditions and long-term outcome of GIST patients with liver metastases in northern China remain unknown.The clinical, pathological, and follow-up data of 144 GIST patients, who had liver metastases between June 1996 and June 2014 from 3 tertiary cancer centers in northern China, were reviewed.Thirty-two cases (22.2%) had hepatectomy with 23 (23/32, 71.9%) R0 resections and 9 (9/32, 28.1%) R1/R2 resections, respectively. Twenty-three patients were given imatinib postoperatively. Furthermore, 98 (68.1%) patients were given TKIs only to control disease progression, and sunitinib was considered after imatinib failure in 12 patients. The 1-, 3- and 5-year survival rate was 82%, 51%, and 24%, with a median overall survival of 48 months for all patients. Patients who had hepatic resection combined with TKIs had a tendency of improved outcome, and the median survival time was 89 months. This was in contrast to patients who received TKIs only, in which median survival time was 53 months. Patients who received imatinib plus sunitinib had a tendency of longer survival time, compared with patients who received imatinib only (not reached vs 50 months).TKIs combined with hepatic resection had a role in improving the outcome of GIST patients with liver metastases.

Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center

“…Similar result was observed in a previous study. 12 One possible reason is that gene mutation weighs more heavily in the development and progression of GIST than in that of colorectal cancer, with secondary mutation found in as high as 80% of progressed GIST lesions. 14 Another reason is that TKI therapy for GIST is far more effective than chemotherapy for colorectal cancer, and the impact of metastatic phase is overshadowed.…”

“…Although there are some studies dealing with patients with GLM, their baseline values and treatment strategies varied greatly: some patients had previous metastasis before spreading to the liver, and some did not receive TKI therapy after the operation. 11 , 12 These variations were associated with a poor survival. 13 Therefore, it is necessary to reassess the value of surgery in this subset of patients with a more balanced dataset.…”

A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study

“…It was reported that more than half of the GIST patients had metastases upon presentation at medical institutions, and the liver was the most common site [ 8 ]. Although complete surgical resection with negative margins is the standard treatment for GIST, over 50% of patients develop recurrence or metastasis [ 9 , 10 ], with liver metastasis being the main metastatic pattern of GIST [ 11 , 12 ]. Hence, the poor prognosis of GISTs might be related to the status of liver metastasis (LIM).…”

Undifferentiated Embryonal Sarcoma of the Liver in Adults

“…GISTs primary to the liver are quite rare (33) when compared to their much more common counterparts in the digestive tract (28). Since GISTs have a well-known propensity to spread to the liver, most GISTs encountered on a liver biopsy will be a metastatic deposit (34,35). Most cases of GIST will be the spindle cell type, composed histologically of a relatively uniform sheet of spindle cells.…”