期刊
HPB
卷 24, 期 6, 页码 986-993出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.hpb.2021.11.011
关键词
-
资金
- GIST Cancer Research Fund
- Jonathan David Foundation
- VA Merit Review Grant [I01BX005358]
- NCI R21 grant [R21CA263400]
Curative-intent hepatectomy is associated with improved overall survival in patients with liver metastatic gastrointestinal stromal tumors (mGIST). However, the oncologic benefit of resecting treatment-resistant lesions remains unclear compared to second-line TKI therapy.
Background: Hepatic resection for metastatic GIST (mGIST) is often performed with either curativeintent or for tyrosine kinase inhibitor (TKI)-resistant lesions. The efficacy of hepatectomy for treatmentresistant lesions (TRL) is uncertain. Methods: We reviewed patients with liver-mGIST treated from 2003 to 2018. Oncologic outcomes including overall (OS), post-operative progression-free survival (PFS), and post-progression OS were evaluated using Kaplan-Meier and Cox proportional hazards modeling. Results: We identified n = 91 patients; 31 (34%) underwent curative-intent hepatectomy, 60 (66%) were initially managed with TKI alone, and 17 (19%) had resection of a TRL. The median follow-up for resected patients was 102 months (range 5- 209 months) with 23 (25%) managed with a major hepatectomy. Patients having curative-intent hepatectomy had 72% 10-year OS following diagnosis of liver-mGIST, compared with 58% (P = 0.50) for TRL resection and 41% (P = 0.01) for non-resected patients. Curative-intent hepatectomy (HR 0.39, P = 0.03) and age (HR 1.04, P = 0.004) were independently associated with 10-year OS, but not TRL resection. TRL resection was not associated with improved post-progression OS compared to second-line TKI therapy (HR 0.61, P = 0.21). Conclusions: Curative-intent hepatectomy is associated with improved OS in liver-mGIST. The oncologic benefit of resecting treatment-resistant liver-mGIST compared to second-line TKI therapy alone remains unclear in the era of multi-line TKI therapy.
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