Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib -- analysis of prognostic factors (EORTC-STBSG collaborative study).
BACKGROUND
Long-term complete remissions remain a rare exception in patients with metastatic gastrointestinal stromal tumors (GIST) treated with IM (imatinib). To date the therapeutic relevance of surgical resection of metastatic disease remains unknown except for the use in palliative intent.


METHODS
We analyzed overall survival (OS) and progression-free survival (PFS) in consecutive patients with metastatic GIST who underwent metastasectomy and received IM therapy (n = 239).


RESULTS
Complete resection (R0+R1) was achieved in 177 patients. Median OS was 8.7 y for R0/R1 and 5.3 y in pts with R2 resection (p = 0.0001). In the group who were in remission at time of resection median OS was not reached in the R0/R1 surgery and 5.1 y in the R2-surgery (p = 0.0001). Median time to relapse/progression after resection of residual disease was not reached in the R0/R1 and 1.9 years in the R2 group of patients, who were resected in response. No difference in mPFS was seen in patients progressing at time of surgery.


CONCLUSIONS
Our analysis implicates possible long-term survival in patients in whom surgical complete remission can be achieved. Incomplete resection, including debulking surgery does not seem to prolong survival. Despite the retrospective character and likely selection bias, this analysis may help in decision making for surgical approaches in metastatic GIST.
Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany. Electronic address: sebastian.bauer@uk-essen.de.
S
S
Bauer
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland.
P
P
Rutkowski
Department of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany.
P
P
Hohenberger
Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
R
R
Miceli
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
E
E
Fumagalli
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland.
J A
JA
Siedlecki
Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
B-P
BP
Nguyen
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
M
M
Kerst
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
M
M
Fiore
Department of General, Liver and Transplant Surgery, Medical University of Warsaw, Poland.
P
P
Nyckowski
Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
M
M
Hoiczyk
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
A
A
Cats
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
P G
PG
Casali
Department of General, Visceral and Transplantion Surgery, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
J
J
Treckmann
Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
F
F
van Coevorden
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
A
A
Gronchi
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D015986:Confounding Factors, Epidemiologic; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D010879:Piperazines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015983:Selection Bias; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
Gastrointestinal stromal tumor; Imatinib; Metastatic disease; Surgery; Survival