Cytoreductive surgery for metastatic gastrointestinal stromal tumors treated with tyrosine kinase inhibitors: A 2-institutional analysis Journal Article


Authors: Fairweather, M.; Balachandran, V. P.; Li, G. Z.; Bertagnolli, M. M.; Antonescu, C.; Tap, W.; Singer, S.; DeMatteo, R. P.; Raut, C. P.
Article Title: Cytoreductive surgery for metastatic gastrointestinal stromal tumors treated with tyrosine kinase inhibitors: A 2-institutional analysis
Abstract: Objective: To refine treatment recommendations for patients with metastatic gastrointestinal stromal tumors (GISTs) treated with tyrosine kinase inhibitors (TKIs) and surgery. Background: Early reports suggested that patients with metastatic GIST responding to TKIs treated with surgery may have favorable outcomes. However, identification of prognostic factors was limited by small cohorts. Methods: Progression-free survival (PFS) and overall survival (OS) from time of surgery and from start of initial TKI was determined. Multivariate analysis was conducted on all patients undergoing GIST metastasectomy between 2001 and 2014 at 2 institutions. Results: We performed 400 operations on 323 patients with metastatic GIST on TKIs. Radiographic response at time of surgery was classified as responsive disease (RD, n = 64, 16%), stable disease (SD, n = 100, 25%), unifocal progressive disease (UPD, n = 132, 33%), and multifocal progressive disease (MPD, n = 104, 26%). For patients on imatinib before surgery, radiographic response was predictive of PFS from time of surgery (RD 36 months, SD 30 months, UPD 11 months, MPD 6 months; P < 0.001) and from imatinib initiation (RD 71 months, SD 51 months, UPD 47 months, MPD 33 months; P < 0.001). Radiographic response was predictive of OS from time of surgery (RD not reached, SD 110 months, UPD 59 months, MPD 24 months; P < 0.001), and from imatinib initiation (RD not reached, SD 144 months, UPD 105 months, MPD 66 months; P = 0.005). Radiographic response was not predictive of PFS/OS for patients on sunitinib. Metastatic mitotic index ≥5/50 HPF, MPD, and R2 resection were prognostic of worse PFS/OS; primary mutation was not. Conclusions: Surgery in metastatic GIST patients in the absence of MPD on imatinib is associated with outcomes at least comparable with second-line sunitinib and may be considered in select patients. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: gastrointestinal stromal tumor; imatinib; prognostic factors; surgery; tyrosine kinase inhibitor; metastasectomy; metastatic
Journal Title: Annals of Surgery
Volume: 268
Issue: 2
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-08-01
Start Page: 296
End Page: 302
Language: English
DOI: 10.1097/sla.0000000000002281
PROVIDER: scopus
PUBMED: 28448384
DOI/URL:
Notes: Article -- Export Date: 1 August 2018 -- Source: Scopus
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MSK Authors
  1. Ronald P Dematteo
    574 Dematteo
  2. Cristina R Antonescu
    585 Antonescu
  3. Samuel Singer
    218 Singer
  4. William Douglas Tap
    108 Tap