title: Has the survival rate for surgically resected gastric gastrointestinal stromal tumors improved in the tyrosine kinase inhibitor era?
abstract: BACKGROUND
  Tyrosine kinase inhibitor (TKI) therapy for patients with gastrointestinal stromal tumors (GISTs) has been shown to improve overall outcomes. It remains unclear whether TKIs are delaying tumor recurrence or actually affecting cure rates. We sought to determine whether changes in overall and disease-specific survival (OS and DSS, respectively) for patients with surgically resected gastric GISTs have been observed after the introduction of TKI therapies by using population-based data.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with resected gastric mesenchymal tumors before the introduction of TKIs (pre-TKI: 1990–1994) and after their inception (post-TKI: 2002–2003).
  
  
  RESULTS
  Overall, 594 patients with gastric mesenchymal tumors were identified, and 189 and 405 underwent resection in the pre- and post-TKI eras, respectively. Between groups, there were no significant differences in patient demographics. The 1- and 6-year OS improved from 84 and 36 to 93 and 71%, respectively. The 1- and 6-year DSS improved from 92 and 62 to 96 and 90%, respectively. Through 6 years, OS and DSS significantly improved for all stages, tumor sizes, and extent of operation. By using multivariate analysis, undergoing treatment in the pre-TKI era was an independent negative predictor of OS, hazard ratio (HR, 2.98) and DSS (HR, 3.81).
  
  
  CONCLUSIONS
  The TKI era is associated with dramatic improvements in OS and DSS for patients with surgically resected gastric GISTs, irrespective of stage, tumor size, and extent of operation through 6 years of follow-up. It remains unclear, however, whether this survival advantage is a change in cure rate or simply a delay in disease progression.
authors.affiliation: Department of Surgery, Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Felipe E
authors.initials: FE
authors.lastname: Pedroso
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
authors.forename: Hong
authors.initials: H
authors.lastname: Xiao
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Koniaris
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors