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Primary surgery as a frontline treatment for synchronous metastatic gastrointestinal stromal tumors: an analysis of the Kinki GIST registry

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Abstract

Purpose

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.

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References

  1. Nishida T, Doi T, Naito Y. Tyrosine kinase inhibitors in the treatment of unresectable or metastatic gastrointestinal stromal tumors. Expert Opin Pharmacother. 2014;15:1979–89.

    Article  CAS  PubMed  Google Scholar 

  2. Mussi C, Ronellenfitsch U, Jakob J, Tamborini E, Reichardt P, Casali PG, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol. 2010;21:403–8.

    Article  CAS  PubMed  Google Scholar 

  3. Zaydfudim V, Okuno SH, Que FG, Nagorney DM, Donohue JH. Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res. 2012;177:248–54.

    Article  PubMed  Google Scholar 

  4. Rubió-Casadevall J, Martinez-Trufero J, Garcia-Albeniz X, Calabuig S, Lopez-Pousa A, Del Muro JG, et al. Role of surgery in patients with recurrent, metastatic, or unresectable locally advanced gastrointestinal stromal tumors sensitive to imatinib: a retrospective analysis of the Spanish Group for Research on Sarcoma (GEIS). Ann Surg Oncol. 2015. [Epub ahead of print].

  5. Turley RS, Peng PD, Reddy SK, Barbas AS, Geller DA, Marsh JW, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer. 2012;118:3571–8.

    Article  PubMed  Google Scholar 

  6. Cananzi FC, Belgaumkar A, Lorenzi B, Mudan S. Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour. ANZ J Surg. 2014;84:937–42.

    Article  PubMed  Google Scholar 

  7. Takaki H, Litchman T, Covey A, Cornelis F, Maybody M, Getrajdman GI, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer. 2014;45:494–9.

    Article  CAS  PubMed  Google Scholar 

  8. Yamanaka T, Takaki H, Nakatsuka A, Uraki J, Fujimori M, Hasegawa T, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol. 2013;24:341–6.

    Article  PubMed  Google Scholar 

  9. Sasaki A, Nitta H, Otsuka K, Fujiwara H, Takahara T, Wakabayashi G. Single-port versus multiport laparoscopic resection for gastric gastrointestinal stromal tumors: a case-matched comparison. Surg Today. 2014;44:1282–6.

    Article  PubMed  Google Scholar 

  10. Blanke CD, Demetri GD, von Mehren M, Heinrich MC, Eisenberg B, Fletcher JA, et al. Long-term results from a randomized phase II trial of standard- vs. higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol. 2008;26:620–5.

    Article  CAS  PubMed  Google Scholar 

  11. Blanke CD, Rankin C, Demetri GD, Ryan CW, von Mehren M, Benjamin RS, et al. Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol. 2008;26:626–32.

    Article  CAS  PubMed  Google Scholar 

  12. Demetri GD, van Oosterom AT, Garrett CR, Blackstein ME, Shah MH, Verweij J, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet. 2006;368:1329–38.

    Article  CAS  PubMed  Google Scholar 

  13. Demetri GD, Reichardt P, Kang YK, Blay JY, Rutkowski P, Gelderblom H, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381:295–302.

    Article  CAS  PubMed  Google Scholar 

  14. Bauer S, Rutkowski P, Hohenberger P, Miceli R, Fumagalli E, Siedlecki JA, et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib—analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol. 2014;40:412–9.

    Article  CAS  PubMed  Google Scholar 

  15. Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373:1097–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schütte J, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307:1265–72.

    Article  CAS  PubMed  Google Scholar 

  17. Pérol D, Ray-Coquard I, Nguyen BB, Adenis A, Rios M, Bertucci F, et al. Explored prognostic factors for survival in patients with advanced GIST treated with standard dose imatinib (IM): results from the BFR14 phase III trial of the French Sarcoma Group. J Clin Oncol. 2012;30:10092 [abstract].

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Acknowledgments

This study was performed by the Kinki GIST Study Group, which includes the following institutions: Osaka University Hospital, Osaka General Medical Center, Shizuoka General Hospital, Osaka National Hospital, Osaka Red Cross Hospital, Toyonaka Municipal Hospital, Tenri Hospital, Osaka City General Hospital, Osaka City University Hospital, Osaka Police Hospital, Sakai Municipal Hospital, Kanazawa Medical University Hospital, Kitano Hospital, Juntendo University Shizuoka Hospital, Osaka Rosai Hospital, Osaka Medical College Hospital, Matsushita Memorial Hospital, Kyoto City Hospital, Shiga Medical Center for Adults, Hyogo Cancer Center, Hoshigaoka Koseinenkin Hospital, Kinki University Hospital, Kansai Electric Power Hospital, National Hospital Organization Osaka Minami Medical Center, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Yodogawa Christian Hospital, Osaka Medical Center for Cancer and Cardiovascular Diseases, Kansai Medical University Takii Hospital, Sumitomo Hospital, Suita Municipal Hospital, The Hospital of Hyogo College of Medicine, Osaka City Sumiyoshi Hospital, Kansai Medical University Hirakata Hospital, Nissei Hospital, Otemae Hospital, Bell Land General Hospital, Minoh City Hospital, Osaka Ekisaikai Hospital, Higashiosaka City General Hospital, and Rinku General Medical Center.

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Authors and Affiliations

  1. Department of Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan

    Shinsuke Sato & Masakazu Takagi

  2. Department of Surgery, Kaizuka City Hospital, Osaka, Japan

    Toshimasa Tsujinaka

  3. Department of Surgery, Osaka National Hospital, Osaka, Japan

    Kazuyoshi Yamamoto

  4. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Tsuyoshi Takahashi

  5. Department of Surgery, Osaka Police Hospital, Osaka, Japan

    Kentaro Kishi

  6. Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan

    Hiroshi Imamura

  7. Department of Surgery, NTT West Osaka Hospital, Osaka, Japan

    Junya Fujita

  8. Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan

    Seiichi Hirota

  9. Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan

    Toshirou Nishida

Authors
  1. Shinsuke Sato
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  2. Toshimasa Tsujinaka
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  3. Kazuyoshi Yamamoto
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  4. Tsuyoshi Takahashi
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  5. Kentaro Kishi
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  6. Hiroshi Imamura
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  7. Junya Fujita
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  8. Masakazu Takagi
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  9. Seiichi Hirota
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  10. Toshirou Nishida
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Corresponding author

Correspondence to Shinsuke Sato.

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Conflict of interest

Toshirou Nishida received funding for clinical research from Novartis and Bayer. The other authors declare no conflicts of interest.

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Sato, S., Tsujinaka, T., Yamamoto, K. et al. Primary surgery as a frontline treatment for synchronous metastatic gastrointestinal stromal tumors: an analysis of the Kinki GIST registry. Surg Today 46, 1068–1075 (2016). https://doi.org/10.1007/s00595-015-1282-4

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  • DOI: https://doi.org/10.1007/s00595-015-1282-4

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