Outcome of 1000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre- and post-imatinib eras Journal Article

Authors: Cavnar, M. J.; Seier, K.; Curtin, C.; Balachandran, V. P.; Coit, D. G.; Yoon, S. S.; Crago, A. M.; Strong, V. E.; Tap, W. D.; Gönen, M.; Antonescu, C. R.; Brennan, M. F.; Singer, S.; DeMatteo, R. P.
Article Title: Outcome of 1000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre- and post-imatinib eras
Abstract: OBJECTIVE: To characterize the results of surgery for gastrointestinal stromal tumor (GIST) in the pre and post-imatinib eras at a single institution and to identify current prognostic clinicopathologic factors. BACKGROUND: Imatinib has radically changed the management of GIST, yet the magnitude of impact on outcome across the spectrum of GIST presentation and relevance of historical prognostic factors are not well defined. METHODS: We retrospectively analyzed 1000 patients who underwent surgery for GIST at our institution from 1982 to 2016. Patients were stratified by presentation status as primary tumor only (PRIM), primary with synchronous metastasis (PRIM + MET), or metachronous recurrence/metastases (MET), and also imatinib era (before and after it became available). Cox proportional-hazard models and Kaplan-Meier methods were used to model and estimate overall survival (OS) and recurrence-free survival (RFS). RESULTS: OS was longer in the imatinib era compared with the pre-imatinib era in each presentation group, including in Miettinen high-risk primary tumors. Among PRIM patients from the pre-imatinib era, tumor site, size, and mitotic rate were independently associated with OS and RFS on multivariate analysis. PRIM patients in the imatinib era who received imatinib (neoadjuvant and/or adjuvant) had higher risk tumors, but after adjusting for treatment, only size >10 cm remained independently prognostic of RFS [hazard ratio (HR) 3.85, 95% confidence interval (CI) 2.00-7.40, P < 0.0001) and OS (HR 3.37, 95% CI 1.60-7.13, P = 0.001)]. CONCLUSIONS: Patients treated in the imatinib era had prolonged OS across all presentations. In the imatinib era, among site, size, and mitotic rate, high-risk features were associated with treatment with the drug, but only size >10 cm correlated with outcome. Imatinib should still be prescribed for patients with high-risk features. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Journal Title: Annals of Surgery
Volume: 273
Issue: 1
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2021-01-01
Start Page: 128
End Page: 138
Language: English
DOI: 10.1097/sla.0000000000003277
PUBMED: 30946076
PROVIDER: scopus
PMCID: PMC6774913
Notes: Article -- Export Date: 1 February 2021 -- Source: Scopus
Citation Impact
MSK Authors
  1. Sam Yoon
    88 Yoon
  2. Murray F Brennan
    977 Brennan
  3. Ronald P DeMatteo
    632 DeMatteo
  4. Mithat Gonen
    822 Gonen
  5. Cristina R Antonescu
    728 Antonescu
  6. Michael Joseph Cavnar
    29 Cavnar
  7. Aimee Marie Crago
    73 Crago
  8. Samuel Singer
    262 Singer
  9. Vivian Strong
    187 Strong
  10. Daniel Coit
    493 Coit
  11. William Douglas Tap
    215 Tap
  12. Christina Elise Curtin
    3 Curtin
  13. Kenneth Seier
    53 Seier