Utilization of Neoadjuvant Therapy in Gastrointestinal Stromal Tumors of the Stomach: Analysis of the 2006-2018 National Cancer Database

被引:2
作者
Kelly, Colleen Hamm [1 ]
Sipok, Arkadii [1 ]
Landry, Jace P. [2 ]
Ramsey, Lolita [1 ]
Joyce, Cara J. [3 ]
Gnerlich, Jennifer L. [1 ]
机构
[1] Inova Fairfax Hosp, Dept Surg, Falls Church, VA 22042 USA
[2] Louisiana State Univ, Dept Surg, Hlth Sci Ctr, New Orleans, LA USA
[3] Loyola Univ Chicago, Stritch Sch Med, Dept Publ Hlth Sci, Maywood, IL USA
关键词
Gastrointestinal stromal tumors (GISTs); Neoadjuvant therapy; Adjuvant therapy; TYROSINE-KINASE INHIBITOR; PHASE-II TRIAL; IMATINIB MESYLATE; SURGICAL RESECTION; PROGNOSTIC-FACTORS; ADJUVANT IMATINIB; SOFT-TISSUE; GIST; PATHOLOGY; UPDATE;
D O I
10.1007/s11605-023-05742-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BackgroundNeoadjuvant tyrosine kinase inhibitor (TKI) therapy has reduced tumor burden and improved survival in both primary and recurrent gastrointestinal stromal tumors (GISTs). However, no clear guidelines exist on optimal patient selection for neoadjuvant therapy (NAT). Our aim was to analyze factors and outcomes associated with the therapeutic sequence of TKI therapy before and/or after surgery for gastric GISTs.MethodsWe performed a retrospective study of patients surgically treated for a gastric GIST utilizing the 2006-2018 National Cancer Database. We examined demographic, clinical, and pathological characteristics associated with NAT versus adjuvant therapy (AT) using logistic regression.ResultsOf the 3732 patients, 20.4% received NAT and 79.6% had AT. Among patients receiving therapy, NAT significantly increased over our study period (12% to 30.7%). A majority of the AT group received a partial gastrectomy (77.9%) compared with the NAT group who received more near-total/total gastrectomy or gastrectomy with en bloc resection (p < 0.001). In a multivariable model, patients were more likely to receive NAT when insured (private, aOR: 2.37, 95% CI: 1.31-4.29), treated at an academic/research program (aOR: 1.83, 95% CI: 1.49-2.56), had tumors located in the proximal stomach (aOR: 1.40, 95% CI: 1.06-1.86), tumor size > 10 cm (aOR: 1.88, 95% CI: 1.41-2.51), and received near-total/total gastrectomy (aOR: 1.81, 95% CI: 1.42-2.29). There were no differences in outcomes.ConclusionNAT for gastric GIST has increased in utilization. NAT was used in patients with larger tumors and who underwent more extensive resection. Despite these factors, outcomes were similar to patients receiving only AT. More studies are required to determine the therapeutic sequence for gastric GISTs.
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页码:1794 / 1803
页数:10
相关论文
共 29 条
[1]   Surgical resection of gastrointestinal stromal tumors after treatment with imatinib [J].
Andtbacka, Robert H. I. ;
Ng, Chaan S. ;
Scaife, Courtney L. ;
Cormier, Janice N. ;
Hunt, Kelly K. ;
Pisters, Peter W. T. ;
Pollock, Raphael E. ;
Benjamin, Robert S. ;
Burgess, Michael A. ;
Chen, Lei L. ;
Trent, Jonathan ;
Patel, Shreyaskumar R. ;
Raymond, Kevin ;
Feig, Barry W. .
ANNALS OF SURGICAL ONCOLOGY, 2007, 14 (01) :14-24
[2]   Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapy for Gastrointestinal Stromal Tumors [J].
Bednarski, Brian K. ;
Araujo, Dejka M. ;
Yi, Min ;
Torres, Keila E. ;
Lazar, Alexander ;
Trent, Jonathan C. ;
Cormier, Janice N. ;
Pisters, Peter W. T. ;
Lev, Dina Chelouche ;
Pollock, Raphael E. ;
Feig, Barry W. ;
Hunt, Kelly K. .
ANNALS OF SURGICAL ONCOLOGY, 2014, 21 (08) :2499-2505
[3]   Impact of surgery on advanced gastrointestinal stromal tumors (GIST) in the imatinib era [J].
Bonvalot, S. ;
Eldweny, H. ;
Le Pechoux, C. ;
Vanel, D. ;
Terrier, P. ;
Cavalcanti, A. ;
Robert, C. ;
Lassau, N. ;
Le Cesne, A. .
ANNALS OF SURGICAL ONCOLOGY, 2006, 13 (12) :1596-1603
[4]   Time to Definitive Failure to the First Tyrosine Kinase Inhibitor in Localized GI Stromal Tumors Treated With Imatinib As an Adjuvant: A European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup Randomized Trial in Collaboration With the Australasian Gastro-Intestinal Trials Group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas [J].
Casali, Paolo G. ;
Le Cesne, Axel ;
Velasco, Andres Poveda ;
Kotasek, Dusan ;
Rutkowski, Piotr ;
Hohenberger, Peter ;
Fumagalli, Elena ;
Judson, Ian R. ;
Italiano, Antoine ;
Gelderblom, Hans ;
Adenis, Antoine ;
Hartmann, Jorg T. ;
Duffaud, Florence ;
Goldstein, David ;
Broto, Javier M. ;
Gronchi, Alessandro ;
Dei Tos, Angelo P. ;
Marreaud, Sandrine ;
van der Graaf, Winette T.A. ;
Zalcberg, John R. ;
Litiere, Saskia ;
Blay, Jean-Yves .
JOURNAL OF CLINICAL ONCOLOGY, 2015, 33 (36) :4276-4283
[5]   Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome [J].
Cavnar, Michael J. ;
Wang, Lin ;
Balachandran, Vinod P. ;
Antonescu, Cristina R. ;
Tap, William D. ;
Keohan, Mary ;
Singer, Sam ;
Temple, Larissa ;
Nash, Garrett M. ;
Weiser, Martin R. ;
Guillem, Jose G. ;
Aguilar, Julio Garcia ;
DeMatteo, Ronald P. ;
Paty, Philip B. .
ANNALS OF SURGICAL ONCOLOGY, 2017, 24 (13) :3972-3980
[6]   Results of tyrosine-kinase inhibitor therapy followed by surgical resection for metastatic gastrointestinal stromal tumor [J].
DeMatteo, Ronald P. ;
Maki, Robert G. ;
Singer, Samuel ;
Gonen, Mithat ;
Brennan, Murray F. ;
Antonescu, Cristina R. .
ANNALS OF SURGERY, 2007, 245 (03) :347-352
[7]   Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial [J].
DeMatteo, Ronald P. ;
Ballman, Karla V. ;
Antonescu, Cristina R. ;
Maki, Robert G. ;
Pisters, Peter W. T. ;
Demetri, George D. ;
Blackstein, Martin E. ;
Blanke, Charles D. ;
von Mehren, Margaret ;
Brennan, Murray F. ;
Patel, Shreyaskumar ;
McCarter, Martin D. ;
Polikoff, Jonathan A. ;
Tan, Benjamin R. ;
Owzar, Kouros .
LANCET, 2009, 373 (9669) :1097-1104
[8]   Two hundred gastrointestinal stromal tumors - Recurrence patterns and prognostic factors for survival [J].
DeMatteo, RP ;
Lewis, JJ ;
Leung, D ;
Mudan, SS ;
Woodruff, JM ;
Brennan, MF .
ANNALS OF SURGERY, 2000, 231 (01) :51-58
[9]  
Demetri George D, 2010, J Natl Compr Canc Netw, V8 Suppl 2, pS1
[10]   Phase II Trial of Neoadjuvant/Adjuvant Imatinib Mesylate (IM) for Advanced Primary and Metastatic/Recurrent Operable Gastrointestinal Stromal Tumor (GIST): Early Results of RTOG 0132/ACRIN 6665 [J].
Eisenberg, Burton L. ;
Harris, Jonathan ;
Blanke, Charles D. ;
Demetri, George D. ;
Heinrich, Michael C. ;
Watson, James C. ;
Hoffman, John P. ;
Okuno, Scott ;
Kane, John M. ;
von Mehren, Margaret .
JOURNAL OF SURGICAL ONCOLOGY, 2009, 99 (01) :42-47