title: Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: A nationwide retrospective study.
abstract: BACKGROUND
  Liver metastases are common in patients with gastrointestinal stromal tumors (GIST). In the absence of randomized controlled clinical trials, the effectiveness of surgery as a treatment modality is unclear. This study identifies safety and outcome in a nationwide study of all patients who underwent resection of liver metastases from GIST.
  
  
  METHODS
  Patients were included using the national registry of histo- and cytopathology (PALGA) of the Netherlands from 1999. Kaplan Meier survival analysis was used for calculating survival outcome. Univariate and multivariate regression analyses were carried out for the assessment of potential prognostic factors.
  
  
  RESULTS
  A total of 48 patients (29 male, 19 female) with a median age of 58 (range 28-81) years were identified. Preoperative and postoperative tyrosine kinase inhibitor therapy was given to 30 (63%) and 36 (75%) patients, respectively. A minor liver resection was performed in 32 patients, 16 patients underwent major liver resection. Median follow-up was 27 (range 1-146) months. Median progression-free survival (PFS) was 28 (range 1-121) months. One-, three-, and five-year PFS was 93%, 67%, and 59% respectively. Median overall survival (OS) was 90 (range 1-146) months from surgery. The one-, three-, and five-year OS was 93%, 80%, and 76% respectively. R0 resection was the only independent significant prognostic factor for DFS and OS at multivariate analysis.
  
  
  CONCLUSIONS
  Resection of liver metastases in GIST patients combined with imatinib may be associated with prolonged overall survival when a complete resection is achieved.
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M F J
authors.initials: MF
authors.lastname: Seesing
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Tielen
authors.affiliation: Department of Surgical Oncology, University Medical Centre Utrecht, Cancer Center, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Coevorden
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, The Netherlands.
authors.forename: K P
authors.initials: KP
authors.lastname: de Jong
authors.affiliation: Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: I D
authors.initials: ID
authors.lastname: Nagtegaal
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Hans.deWilt@Radboudumc.nl.
authors.forename: J H W
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000556:secondary / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: Gastrointestinal stromal cancer; Liver metastasis; Liver resection