Patients developing metastatic gastrointestinal stromal tumors (mGIST) have heterogenous disease biology and oncologic outcomes; prognostic factors are incompletely characterized. We sought to evaluate predictors of 10-year metastatic survivorship in the era of tyrosine kinase inhibitor (TKI) therapy.
We reviewed patients with mGIST treated at our Comprehensive Cancer Center from 2003 to 2019, including only patients with either mortality or 10 years of follow-up. Ten-year survivorship was evaluated with logistic regression.
We identified 109 patients with a median age of 57 years at mGIST diagnosis. Synchronous disease was present in 57% (n = 62) of patients; liver (n = 48, 44%), peritoneum (n = 40, 37%), and liver + peritoneum (n = 18, 17%) were the most common sites. Forty-six (42%) patients were 10-year mGIST survivors. Following mGIST diagnosis, radiographic progression occurred within 2 years in 53% (n = 58) of patients, 2–5 years in 16% (n = 17), and 5–10 years in 16% (n = 17), with median survival of 32, 76, and 173 months, respectively. Seventeen (16%) patients had not progressed by 10 years.
Fifty-two (47%) patients underwent metastasectomy, which was associated with improved progression-free survival (hazard ratio 0.63, p = 0.04). In patients experiencing progression, factors independently associated with 10-year survivorship were age (odds ratio [OR] 0.96, p = 0.03) and time to progression (OR 1.71/year, p < 0.001).
Ten-year survivorship is achievable in mGIST in the era of TKIs and is associated with younger age and longer time to first progression, while metastasectomy is associated with longer time to first progression. The role of metastasectomy in the management of patients with disease progression receiving TKI therapy merits further study.
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MCH received partial salary support from the following sources: a research grant from the Jonathan David Foundation, a VA Merit Review Grant (I01BX005358), and from NCI R21 Grant (R21CA263400).
Michael Heinrich receives consulting fees from Novartis, Deciphera Pharmaceuticals, Blueprint Medicines, and Theseus Pharmaceuticals, and holds multiple patents on the diagnosis and/or treatment of GIST. One patent on the treatment of GIST has been licensed by OHSU to Novartis. Thomas L. Sutton, Brett S. Walker, Kevin G. Billingsley, Christopher L. Corless, Brett C. Sheppard, and Skye C. Mayo have no conflicts of interest to declare.
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Sutton, T.L., Walker, B.S., Billingsley, K.G. et al. Ten-Year Survivorship in Patients with Metastatic Gastrointestinal Stromal Tumors. Ann Surg Oncol 29, 7123–7132 (2022). https://doi.org/10.1245/s10434-022-12063-5