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

Abstract

ObjectivesGastrointestinal stromal tumor (GIST) liver metastasis (GLM) is a special subset of advanced GIST, because its lesions are easier to define and assess. We aim to determine the role of liver metastasectomy for patients with GLM in the era of tyrosine kinase inhibitor (TKI) therapy.MethodsWe reviewed patients with metastatic GIST who received surgery or other treatments in Sun Yat-sen University Cancer Center between January 1991 and December 2017. Patients with metastases confined to the liver and with no previous metastasis to other locations were included into the study and were classified into surgical and non-surgical groups. All patients received 400 mg/d imatinib after the operation. We compared progression-free survival (PFS) and overall survival (OS) between the two groups.ResultsA total of 102 patients were included into the study. Of them, 21 (20.1%) underwent surgery for liver metastases and 81 (79.9%) received TKI therapy alone. During the operation, six patients received radiofrequency ablation for suspicious or unresectable lesions. Three-year PFS rate was 77.5% in the surgical group and 65.5% in the non-surgical group (P=0.027); 5-year OS rate was 85.7% and 59.6%, respectively (P=0.008). About 22.1% of patients had metastases of less than three in the surgical group, while the rate was 42.9% in the non-surgical group (P=0.011). Patients with metastases of less than three had longer PFS than those with three or more, with a 3-year PFS rate of 72.8% and 65.8%, respectively (P=0.019). But their difference in 5-year OS rate was not significant (91.7% vs 55.3%, P=0.08).ConclusionFollowed by continuous TKI therapy, R0 surgery significantly prolongs the survival of patients with GLM, regardless of the extent of disease or the phase of metastasis.

Role of Surgery in the Management of Liver Metastases From Gastrointestinal Stromal Tumors

“…In the propensity model, addition of surgery was still associated with better PFS and OS in both univariate and multivariate analyses. Previous studies reported a 3y PFS of 25.6%-77.5% for patients receiving surgery for liver metastases from GIST, which is inferior to our result (17,19,22,25,26). The difference in survival is probably attributed to the inclusion of patients with more advanced disease such as extrahepatic metastases and imatinib resistance in previous studies.…”

“…A Japanese prospective, multicenter trial was once conducted to clarify the efficacy and safety of surgery for liver oligometastasis but was prematurely terminated due to the amendment of the guideline and poor accrual (18). Several retrospective studies conducted in the last decade have indicated survival benefit from adding hepatectomy in the treatment of metastatic GIST, but were limited statistically by small sample size as well as their heterogeneity (19)(20)(21)(22)(23)(24)(25)(26). To better demonstrate the clinical benefit of hepatectomy, we adopted strict inclusion criteria and collected a relatively homogenous cohort of patients with liver metastases from GIST.…”

Surgery Prolongs the Survival of Patients with Metastatic, Recurrent, or Unresectable Locally Advanced Gastrointestinal Stromal Tumors Response to Imatinib Mesylate Treatment: A Systematic Review and Meta-analysis

“…A total of 10 studies [25][26][27][28][29][30][31][32][33][34] including 1119 patients (361 patients in the surgery group and 758 patients in the no surgery group) met the eligibility criteria and were included in the nal analysis (Figure 1). Manual searches of the references lists of the included studies did not yield any further studies.…”

“…Studies that contain patients with PD were excluded. A total of 7 studies 25,[28][29][30][31][32]34 including 863 patients (240 patients in the surgery group and 621 patients in the no surgery group) were included in the subgroup analyses. Subgroup analysis results were consistent with the overall results (OS: HR, 0.67; 95% CI, 0.55 to 0.81; P < 0.0001; Figure 3A; PFS: HR, 0.62; 95% CI, 0.46 to 0.82; P = 0.009; Figure 3B).…”

“…One randomized control trial 28 and 4 retrospective studies 27,30,33,34 with scores of six or higher on the NOS were included in the sensitivity analysis. The results related to OS and PFS did not changed signi cantly in the sensitivity analysis (shown in supplementary material Figure S1 and Figure S2).…”