Outcome of metastatic GIST in the era before tyrosine kinase inhibitors Journal Article
| Authors: | Gold, J. S.; Van Der Zwan, S. M.; Gonen, M.; Maki, R. G.; Singer, S.; Brennan, M. F.; Antonescu, C. R.; DeMatteo, R. P. |
| Article Title: | Outcome of metastatic GIST in the era before tyrosine kinase inhibitors |
| Abstract: | Background: Treatment of metastatic GIST with imatinib mesylate results in a 2-year survival of approximately 72%. The outcome of patients with metastatic GIST not treated with tyrosine kinase inhibitors is not well defined. Methods: One hundred nineteen patients with metastatic GIST diagnosed prior to July 1, 1998 (approximately 2 years prior to the use of imatinib for GIST) were identified from an institutional database of patients with pathologically confirmed GIST. Mutational analysis was performed in cases with available tissue. The log rank test and Cox regression models were used to assess prognostic factors. Results: Median survival was 19 months with a 41% 2-year survival and a 25% 5-year survival. Resection of metastatic GIST was performed in 81 patients (68%), while 50 (42%) received conventional chemotherapy. Twelve patients (10%) were eventually started on imatinib. Primary tumor size <10 cm, <5 mitoses/50 HPF in the primary tumor, epithelioid morphology, longer disease-free interval, and surgical resection were independent predictors of improved survival on multivariate analysis. Mutational status did not predict outcome. In patients who underwent resection, the 2 year survival was 53%, and negative microscopic margins also independently predicted improved survival. Conclusions: Treatment with imatinib appears to improve 2-year survival of metastatic GIST by approximately 20% when compared to surgery alone. The combination of imatinib and surgery for the treatment of metastatic GIST therefore warrants investigation. © 2006 Society of Surgical Oncology. |
| Keywords: | adult; cancer chemotherapy; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; major clinical study; clinical trial; antineoplastic agents; gastrointestinal stromal tumor; imatinib; gastrointestinal stromal tumors; metastasis; tumor volume; pyrimidines; mutational analysis; morphology; protein tyrosine kinase inhibitor; protein kinase inhibitors; gastrointestinal neoplasms; survival time; proportional hazards model; surgery; disease free interval; multivariate analysis; piperazines; gist; log rank test; imatinib mesylate; gleevec |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 14 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2007-01-01 |
| Start Page: | 134 |
| End Page: | 142 |
| Language: | English |
| DOI: | 10.1245/s10434-006-9177-7 |
| PUBMED: | 17080234 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 44" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus" |
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