TY - JOUR
T1 - Feasibility and Timing of Cytoreduction Surgery in Advanced (Metastatic or Recurrent) Gastrointestinal Stromal Tumors during the Era of Imatinib
AU - Chang, Shih Chun
AU - Liao, Chien Hung
AU - Wang, Shang Yu
AU - Tsai, Chun Yi
AU - Chiang, Kun Chun
AU - Cheng, Chi Tung
AU - Yeh, Ta Sen
AU - Chen, Yen Yang
AU - Ma, Ming Chun
AU - Liu, Chien Ting
AU - Yeh, Chun Nan
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - The prognosis of advanced gastrointestinal stromal tumors (GISTs) was dramatically improved in the era of imatinib. Cytoreduction surgery was advocated as an additional treatment for advanced GISTs, especially when patients having poor response to imatinib or developing resistance to it. However, the efficacy and benefit of cytoreduction were still controversial. Likewise, the sequence between cytoreduction surgery and imatinib still need evaluation. In this study, we tried to assess the feasibility and efficiency of cytoreduction in advanced GISTs. Furthermore, we analyzed the impact of timing of the cytoreduction surgery on the prognosis of advanced GISTs. We conducted a prospective collecting retrospective review of patients with advanced GISTs (metastatic, unresectable, and recurrent GISTs) treated in Chang Gung memorial hospital (CGMH) since 2001 to 2013. We analyzed the impact of cytoreduction surgery to response to imatinib, progression-free survival (PFS), and overall survival (OS) in patients with advanced GISTs. Moreover, by the timing of cytoreduction to imatinib, we divided the surgical patients who had surgery before imatinib use into early group and those who had surgery after imatinib into late. We compared the clinical response to imatinib, PFS and OS between early and late cytoreduction surgical groups. Totally, 182 patients were enrolled into this study. Seventy-six patients underwent cytoreduction surgery. The demographic characteristics and tumor presentation were similar between surgical and nonsurgical groups. The surgical group showed better complete response rate (P<0.001) and partial response rate (P=0.008) than non-surgical group. The 1-year, 3-year, and 5-year PFS were significantly superior in surgical group (P=0.003). The 1-year, 3-year, and 5-year OS were superior in surgical group, but without statistical significance (P Combining imatinib with cytoreduction increased the response rate to imatinib and prolonged PFS in patients with advanced GISTs. Moreover, early and late cytoreduction surgery was comparable in prognosis, although late cytoreduction revealed higher complete resection rate.
AB - The prognosis of advanced gastrointestinal stromal tumors (GISTs) was dramatically improved in the era of imatinib. Cytoreduction surgery was advocated as an additional treatment for advanced GISTs, especially when patients having poor response to imatinib or developing resistance to it. However, the efficacy and benefit of cytoreduction were still controversial. Likewise, the sequence between cytoreduction surgery and imatinib still need evaluation. In this study, we tried to assess the feasibility and efficiency of cytoreduction in advanced GISTs. Furthermore, we analyzed the impact of timing of the cytoreduction surgery on the prognosis of advanced GISTs. We conducted a prospective collecting retrospective review of patients with advanced GISTs (metastatic, unresectable, and recurrent GISTs) treated in Chang Gung memorial hospital (CGMH) since 2001 to 2013. We analyzed the impact of cytoreduction surgery to response to imatinib, progression-free survival (PFS), and overall survival (OS) in patients with advanced GISTs. Moreover, by the timing of cytoreduction to imatinib, we divided the surgical patients who had surgery before imatinib use into early group and those who had surgery after imatinib into late. We compared the clinical response to imatinib, PFS and OS between early and late cytoreduction surgical groups. Totally, 182 patients were enrolled into this study. Seventy-six patients underwent cytoreduction surgery. The demographic characteristics and tumor presentation were similar between surgical and nonsurgical groups. The surgical group showed better complete response rate (P<0.001) and partial response rate (P=0.008) than non-surgical group. The 1-year, 3-year, and 5-year PFS were significantly superior in surgical group (P=0.003). The 1-year, 3-year, and 5-year OS were superior in surgical group, but without statistical significance (P Combining imatinib with cytoreduction increased the response rate to imatinib and prolonged PFS in patients with advanced GISTs. Moreover, early and late cytoreduction surgery was comparable in prognosis, although late cytoreduction revealed higher complete resection rate.
UR - http://www.scopus.com/inward/record.url?scp=84941331745&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000001014
DO - 10.1097/MD.0000000000001014
M3 - 文章
C2 - 26091448
AN - SCOPUS:84941331745
SN - 0025-7974
VL - 94
JO - Medicine (United States)
JF - Medicine (United States)
IS - 24
M1 - e1014
ER -