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Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry

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Abstract

Purpose

To define the role of surgery for metastatic/recurrent lesions after resection of primary gastrointestinal stromal tumors (GISTs).

Methods

Based on data obtained from the Kinki GIST registry, patients with recurrence or metastasis were divided into a surgical treatment group (ST group), comprised those treated with surgery in addition to tyrosine kinase inhibitor (TKI) therapy; and a drug treatment group (DT group), comprised those treated with TKI therapy alone. We compared the baseline characteristics and survival outcomes of the groups.

Results

Metastasis or recurrence developed in 93 of the 737 patients with GISTs treated between 2003 and 2007, 50 (53.8 %) of whom were assigned to the ST group and 43 (46.2 %) to the DT group. In the ST group, the 5-year overall survival rate was significantly higher for patients who underwent R0/R1 resection than for those who underwent R2 resection (82.2 vs. 47.0 %, p = 0.018). Survival time after recurrence was correlated with the duration of total TKI therapy in both the ST and DT groups (r = 0.766 and r = 0.932, respectively, p < 0.001).

Conclusions

Continuous TKI therapy appears to be important primarily for the prognostic improvement of patients with recurrent/metastatic GISTs. R0/R1 resection may have benefits when combined with TKI therapy for patients with stable disease or disease responsive to TKI therapy, less than four metastatic lesions, and lesions <100 mm in total.

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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, Bellland 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 Police Hospital, Osaka, Japan

    Toru Masuzawa

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

    Kazuyoshi Yamamoto

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

    Tsuyoshi Takahashi

  6. Department of Surgery, Osaka City General Hospital, Osaka, Japan

    Yoshito Yamashita

  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. Toru Masuzawa
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  4. Kazuyoshi Yamamoto
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  5. Tsuyoshi Takahashi
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  6. Yoshito Yamashita
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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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Sato, S., Tsujinaka, T., Masuzawa, T. et al. Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today 47, 58–64 (2017). https://doi.org/10.1007/s00595-016-1351-3

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  • DOI: https://doi.org/10.1007/s00595-016-1351-3

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