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2015 ; 94
(24
): e1014
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gab.com Text
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Feasibility and Timing of Cytoreduction Surgery in Advanced (Metastatic or
Recurrent) Gastrointestinal Stromal Tumors During the Era of Imatinib
#MMPMID26091448
Chang SC
; Liao CH
; Wang SY
; Tsai CY
; Chiang KC
; Cheng CT
; Yeh TS
; Chen YY
; Ma MC
; Liu CT
; Yeh CN
Medicine (Baltimore)
2015[Jun]; 94
(24
): e1014
PMID26091448
show ga
The prognosis of advanced gastrointestinal stromal tumors (GISTs) was
dramatically improved in the era of imatinib. Cytoreduction surgery was advocated
as an additional treatment for advanced GISTs, especially when patients having
poor response to imatinib or developing resistance to it. However, the efficacy
and benefit of cytoreduction were still controversial. Likewise, the sequence
between cytoreduction surgery and imatinib still need evaluation. In this study,
we tried to assess the feasibility and efficiency of cytoreduction in advanced
GISTs. Furthermore, we analyzed the impact of timing of the cytoreduction surgery
on the prognosis of advanced GISTs. We conducted a prospective collecting
retrospective review of patients with advanced GISTs (metastatic, unresectable,
and recurrent GISTs) treated in Chang Gung memorial hospital (CGMH) since 2001 to
2013. We analyzed the impact of cytoreduction surgery to response to imatinib,
progression-free survival (PFS), and overall survival (OS) in patients with
advanced GISTs. Moreover, by the timing of cytoreduction to imatinib, we divided
the surgical patients who had surgery before imatinib use into early group and
those who had surgery after imatinib into late. We compared the clinical response
to imatinib, PFS and OS between early and late cytoreduction surgical groups.
Totally, 182 patients were enrolled into this study. Seventy-six patients
underwent cytoreduction surgery. The demographic characteristics and tumor
presentation were similar between surgical and non-surgical groups. The surgical
group showed better complete response rate (P .001) and partial response rate
(P = 0.008) than non-surgical group. The 1-year, 3-year, and 5-year PFS were
significantly superior in surgical group (P = 0.003). The 1-year, 3-year, and
5-year OS were superior in surgical group, but without statistical significance
(P = 0.088). Dividing by cytoreduction surgical timing, the demographic
characteristics and tumor presentation were comparable in early and late groups.
The late cytoreduction group presented higher R0 resection rate (59.1% vs 31.5%,
P = 0.025). However, the PFS and OS were comparable in both groups.Combining
imatinib with cytoreduction increased the response rate to imatinib and prolonged
PFS in patients with advanced GISTs. Moreover, early and late cytoreduction
surgery was comparable in prognosis, although late cytoreduction revealed higher
complete resection rate.
|Adult
[MESH]
|Aged
[MESH]
|Antineoplastic Agents/therapeutic use
[MESH]
|Benzamides/administration & dosage/*therapeutic use
[MESH]