Journal
CHIRURGIA
Volume 116, Issue 4, Pages 438-450Publisher
EDITURA CELSIUS
DOI: 10.21614/chirurgia.116.4.438
Keywords
gastrointestinal stromal tumors; hepatectomy; combined modality therapy; propensity score matching; bootstrapping selection with Jackknife correction for errors; survival
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This study found that overall survival of patients with gastrointestinal liver metastases undergoing hepatic resection alongside systemic therapies is significantly higher compared to those receiving only systemic therapies. The presence of synchronous liver metastases was identified as a risk factor through multivariate analysis.
Background & Aims: The emergence of tyrosine kinase inhibitors, radically altered the management of GISTs and sparked controversy regarding the role of hepatic resection for metastatic tumors. This study aims to identify whether there is improvement in the overall survival of patients with gastrointestinal liver metastases, undergoing hepatic resection in the context of multimodal treatment strategy, as to those approached only by systemic therapy. Methods: Using a retrospective database, we identified 57 patients treated at our center over a 12-year period: Group A (n=31) underwent hepatic resection alongside systemic therapies, and B (n=26) only systemic therapies. In order to obtain a more robust sample, needed for the survival analysis, we performed a propensity score matching and a bootstrapping selection with Jackknife correction for errors; thus, we created an extended sample of 1000 virtual patients. Results: The overall survival measured in all patients was 47 months (95%CI:34-60); significantly higher for group A (56 months, 95%CI:37-75) compared to group B (38 months, 95%CI:19-56), (p=0.007, Log Rank test). Multivariate analysis identified one risk factor: the presence synchronous liver metastases upon diagnosis of primary. Conclusions: Liver resection following TKI therapy is the current mainstay of treatment strategy for potential cure and prolonged survival, in appropriately selected patients evaluated in an multidisciplinary tumor board.
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