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Outcome of Metastatic GIST in the Era before Tyrosine Kinase Inhibitors

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Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 28 July 2007

An Erratum to this article was published on 28 July 2007

Abstract

Background

Treatment of metastatic GIST with imatinib mesylate results in a 2-year survival of approximately 72%. The outcome of patients with metastatic GIST not treated with tyrosine kinase inhibitors is not well defined.

Methods

One hundred nineteen patients with metastatic GIST diagnosed prior to July 1, 1998 (approximately 2 years prior to the use of imatinib for GIST) were identified from an institutional database of patients with pathologically confirmed GIST. Mutational analysis was performed in cases with available tissue. The log rank test and Cox regression models were used to assess prognostic factors.

Results

Median survival was 19 months with a 41% 2-year survival and a 25% 5-year survival. Resection of metastatic GIST was performed in 81 patients (68%), while 50 (42%) received conventional chemotherapy. Twelve patients (10%) were eventually started on imatinib. Primary tumor size <10 cm, <5 mitoses/50 HPF in the primary tumor, epithelioid morphology, longer disease-free interval, and surgical resection were independent predictors of improved survival on multivariate analysis. Mutational status did not predict outcome. In patients who underwent resection, the 2 year survival was 53%, and negative microscopic margins also independently predicted improved survival.

Conclusions

Treatment with imatinib appears to improve 2-year survival of metastatic GIST by approximately 20% when compared to surgery alone. The combination of imatinib and surgery for the treatment of metastatic GIST therefore warrants investigation.

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Acknowledgments

Supported in part by: PO1 CA 47179 (MFB), ACS MRSG CCE-106841 (CRA), and CA94503 and CA102613 (RPD).

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Authors and Affiliations

  1. Departments of Surgery (JSG, SMV, SS, MFB, RPD), Epidemiology and Biostatistics (MG), Medicine (RGM), and Pathology (CRA), Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Jason S. Gold MD, Sanne M. van der Zwan MD, Mithat Gönen PhD, Robert G. Maki MD, PhD, Samuel Singer MD, Murray F. Brennan MD, Cristina R. Antonescu MD & Ronald P. DeMatteo MD

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA

    Ronald P. DeMatteo MD

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  1. Jason S. Gold MD
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  2. Sanne M. van der Zwan MD
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  3. Mithat Gönen PhD
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  4. Robert G. Maki MD, PhD
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  5. Samuel Singer MD
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  7. Cristina R. Antonescu MD
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  8. Ronald P. DeMatteo MD
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Correspondence to Ronald P. DeMatteo MD.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1245/s10434-006-9297-0

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Gold, J.S., van der Zwan, S.M., Gönen, M. et al. Outcome of Metastatic GIST in the Era before Tyrosine Kinase Inhibitors. Ann Surg Oncol 14, 134–142 (2007). https://doi.org/10.1245/s10434-006-9177-7

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  • DOI: https://doi.org/10.1245/s10434-006-9177-7

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