title: Primary surgery as a frontline treatment for synchronous metastatic gastrointestinal stromal tumors: an analysis of the Kinki GIST registry.
abstract: OBJECTIVE
  To investigate the outcomes of a combined treatment regimen comprising primary surgery and tyrosine kinase inhibitor (TKI) therapy for synchronous metastatic gastrointestinal stromal tumors (GIST).
  
  
  METHODS
  We analyzed retrospectively 14 cases of synchronous metastatic GIST from the Kinki GIST registry between 2003 and 2007.
  
  
  RESULTS
  The primary tumor was located in the stomach, small intestine, and rectum in seven, six, and one patients, respectively. Metastatic tumors developed in the liver, peritoneum, other sites, and multiple organs in three, six, two, and three patients, respectively. The R0 resection rate was 42.9 % and the 5-year overall survival rate was 69.3 %. There was no significant difference in the 5-year overall survival rate between patients who underwent R0/R1 and those who underwent R2 resection (71.4 vs. 68.6 %). There was a strong correlation between survival time from diagnosis and the duration of imatinib therapy (Pearson's correlation coefficient, 0.86; p < 0.001).
  
  
  CONCLUSIONS
  Although the role of surgery in the treatment of synchronous metastatic GIST is still unclear, primary surgery as the sole frontline treatment may not have a survival benefit: Continuous TKI therapy is more important for prolonging survival.
authors.affiliation: Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan. shinsukesato@gmail.com.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Surgery, Kaizuka City Hospital, Osaka, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Osaka Police Hospital, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Department of Surgery, NTT West Osaka Hospital, Osaka, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
authors.affiliation: Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
authors.affiliation: Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000368:Aged; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use; D007564:Japan; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: Gastrointestinal stromal tumors; Radiofrequency ablation; Surgery; Synchronous metastasis