Primary Tumor Resection Improves Survival in Patients With Metastatic Gastrointestinal Stromal Tumors: A Preliminary Population-Based Analysis

Abstract

Background: Surgery has been the primary treatment in patients with localized gastrointestinal stromal tumors (GISTs) for many decades, whereas it remains controversial regarding the efficacy of primary tumor resection for metastatic GISTs treated with chemotherapy, and likewise it is unclear who would benefit from the surgical resection. Methods: GISTs patients with distant metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of surgery on survival. Results: In total, of 455 patients with metastatic GISTs, 235 patients (51.6%) underwent primary tumor resection and 220 patients (48.4%) did not. Median survival of patients in resection group was 72 (95% CI: 62.90-81.10) months vs. 40 (95% CI: 29.53-50.47) months for those in non-resection group (p < 0.001). Similarly, surgery in conjunction with chemotherapy led to a favorable impact on survival than chemotherapy alone (OS: 72 vs. 40 months, p < 0.001; CSS: 74 vs. 44 months, p < 0.001). Multivariable analysis showed that both OS (HR: 0.581, 95% CI: 0.386-0.874, p = 0.009) and CSS (HR: 0.663, 95% CI: 0.439-0.912, p = 0.042] were dramatically improved in patients with surgical removal of primary site, as well as primary tumor size between 5 and 10 cm, while increasing age was predictive of poorer survival. Stratified analysis revealed that patients with tumor locations in the stomach demonstrated a prolonged survival after surgery, with no significant differential surgical effect between the stomach and small intestine. Conclusions: Our study preliminarily suggests that carefully selected patients with metastatic GISTs might prolong survival after treatment of surgery, especially those with a primary tumor between 5 and 10 cm and a tumor located in the stomach.

Update of epidemiology, survival and initial treatment in patients with gastrointestinal stromal tumour in the USA: a retrospective study based on SEER database

“…Consistent with previous studies, stomach and small intestine were the major sites of GIST occurrence in the USA,6 as well as among metastatic GIST patients 11. In this study, we found an increasing trend of ASIRs for stomach GIST, but not for small intestine GIST or GIST located in uncommon sites.…”

“…The probable reason could be the high efficacy of imatinib in terms of survival for metastatic or advanced GIST 26 27. Be that as it may, resection of primary tumour could significantly improve the survival of metastatic GIST patients,11 17 28–32 especially combined with target therapy. Even for part of highly select unresectable GIST, receiving cytoreductive surgery combined with target therapy could benefit for survival 33.…”

“…For studies focused on epidemiology data of GIST after 2001, most of them only paid attention to a single site,3 6–8 the difference of incidence among different primary sites were not well addressed. In addition, most studies earlier focused on identifying the risk factors and developing nomogram for predict survival,9–12 literatures are lack on the pattern of initial treatment for GIST, and survival trend in the last decade. Hence, an updated data regarding the epidemiology, survival and treatment of GIST are of interest.…”