title: Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis.
abstract: The impact and management of microscopically positive margins in gastrointestinal stromal tumors (GISTs) remain unclear. The aim of this study is to estimate the prognostic value of surgical margins for disease-free survival (DFS) and overall survival (OS) in patients with primary GISTs. Twelve studies with 1985 GIST patients were included. The overall recurrence rate in R1 resection and R0 resection group was 0.364 (95% CI 0.299-0.429) and 0.296 (95% CI 0.161-0.430), respectively. Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128-2.258; I(2) = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608-3.363; I(2) = 60.8%, P value = 0.013). Importantly, subgroup analysis revealed that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. (HR 1.308, 95% CI 0.583-2.935; I(2) = 53.2%, P value = 0.074). The level of evidence achieved in this study was "moderate" for DFS and "low" for OS. In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Zhi
authors.affiliation: Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, 6 West Beijing Road, Huai'an 223001, China.
authors.forename: Baofei
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Emergency Department, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Junbo
authors.initials: J
authors.lastname: Yu
authors.affiliation: Clinical Cancer Research Center, Aalborg University Hospital, Clinical Institute, Aalborg, Denmark.|Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.|Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Oluf Dimitri
authors.initials: OD
authors.lastname: Røe
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Qin
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Ni
authors.affiliation: Research Division of Clinical Pharmacology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
authors.forename: Luning
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Meirong
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.
authors.forename: Lilin
authors.initials: L
authors.lastname: Ma
mesh_terms: D018572:Disease-Free Survival; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D000072662:Margins of Excision; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D017594:Publication Bias