The efficacy of adjuvant imatinib therapy in improving the prognosis of patients with colorectal gastrointestinal stromal tumourss

Abstract

INTRODUCTION Although it has now been accepted that imatinib is a valid treatment for gastrointestinal stromal tumour (GIST) patients in the adjuvant setting, information on its clinical efficacy in improving the prognosis for patients with colorectal GISTs is limited. METHODS The clinical and follow-up records of 42 colorectal GIST patients who underwent surgical resection at our institution between January 2004 and December 2013 were reviewed retrospectively. The effect of postoperative imatinib treatment on recurrence free survival and overall survival time was analysed with the Kaplan-Meier method and the multivariate Cox proportional hazards model. RESULTS Sixteen patients were assigned to imatinib treatment (imatinib group) after surgical tumour resection while twenty-six patients did not receive any adjuvant treatment (control group). The one, three and five-year recurrence free survival rates were 100%, 90% and 77% respectively. This was significantly higher than in the control group (92%, 53% and 36%) (logrank test, p=0.012). The one, three and five-year overall survival rates were 100%, 91% and 68% in the imatinib group compared with 96%, 77% and 39% in the control group (logrank test, p=0.021). Analysis with the multivariate Cox regression model yielded similar results on the efficacy of adjuvant imatinib in prolonging both recurrence free survival (hazard ratio [HR]: 0.23, 95% confidence interval [CI]: 0.07-0.80) and overall survival (HR: 0.20, 95% CI: 0.05-0.91). CONCLUSIONS Adjuvant imatinib therapy seems to be effective in decreasing the risk of tumour occurrence and prolonging the overall survival time in colorectal GIST patients.

Prognostic Factors and Management of Colorectal Gastrointestinal Stromal Tumors

“…Dematteo et al 52 reported a longer RFS in patients receiving adjuvant imatinib (HR ¼ 0.35; 95% CI 0.22-0.53; p < 0.0001). Similarly, a study published in 2015 6 reported an improved RFS (HR ¼ 0.23; 95% CI 0.07-0.80; p ¼ 0.012) and OS (HR ¼ 0.20; 95% CI 0.05-0.91; p ¼ 0.021) in colorectal GIST patients receiving imatinib after surgery. Different studies have also reported an association between adjuvant therapy, longer DFS (HR ¼ 0.365; 95% CI 0.199-0.918; p ¼ 0.023), 8 and longer OS (HR ¼ 0.262; 95% CI 0.122-0.563; p ¼ 0.001).…”

“…3 4 5 In fact, they account for only 0.1% of all colorectal malignancies. 6 Additionally, GISTs located in the esophagus, greater omentum and mesentery are even rarer. 1…”

“…[3][4][5] In fact, they account for only 0.1% of all colorectal malignancies. 6 Additionally, GISTs located in the esophagus, greater omentum and mesentery are even rarer. 1 Studies show that GISTs arise from the interstitial cells of Cajal, which can be found in the myenteric and submucosal plexus of the GI tract.…”

Assessing prognostic factors of long‐term survival after surgery for colorectal gastrointestinal stromal tumours

“…Previous smaller retrospective studies have reported oncological outcomes in patients who underwent surgery for CR GIST with 5-year RFS rates ranging from 77% to 100% and 5-year overall survival (OS) rates ranging from 68% to 100% [13,14,22,23]. In the most recent large population database study of 1548 patients, the 5-and 10-year OS of CR GIST was reported to be 61% and 45%, respectively [14].…”

Development and validation of a prognostic model to predict the prognosis of patients with colorectal gastrointestinal stromal tumor: A large international population-based cohort study

“…Meanwhile, colorectal GISTs remain a predicament for clinicians and scientists to predict clinical behavior. Previous studies have reported the prognostic factors affecting prognosis in the patients with colorectal GISTs, but the majority of the published literature concerning the characteristics, incidence, survival, and treatment strategies of colorectal GISTs has been case reports or small case series ( 7 , 36 – 38 ). Although these findings advanced our understanding of colorectal GISTs, they may be particularly susceptible to patient selection bias and institutional bias, and there is still a voracious need for more information on this uncommon malignant tumor.…”