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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2014

01-08-2014 | Bone and Soft Tissue Sarcomas

Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapy for Gastrointestinal Stromal Tumors

Authors: Brian K. Bednarski, MD, Dejka M. Araujo, MD, Min Yi, MD, PhD, Keila E. Torres, MD, PhD, Alexander Lazar, MD, PhD, Jonathan C. Trent, MD, PhD, Janice N. Cormier, MD, MPH, Peter W. T. Pisters, MD, Dina Chelouche Lev, MD, Raphael E. Pollock, MD, PhD, Barry W. Feig, MD, Kelly K. Hunt, MD

Published in: Annals of Surgical Oncology | Issue 8/2014

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Abstract

Background

Management of gastrointestinal stromal tumors (GISTs) has been transformed with tyrosine kinase inhibitors (TKIs). While data on optimal duration of adjuvant imatinib remains elusive, guidelines for administration of neoadjuvant TKIs remain unknown.

Methods

Under an institutional review board-approved protocol, patients at our institution with a diagnosis of GIST treated with neoadjuvant TKIs and surgical resection were identified. Clinical and pathologic characteristics were obtained from medical records.

Results

Ninety-three patients underwent surgical resection after neoadjuvant TKI therapy; 41 had primary and 52 had recurrent/metastatic GIST. Median follow-up was 2.4 years. Median duration of neoadjuvant therapy was 315 (range 3–1,611) days for primary and 537 (range 4–3,257) days for recurrent/metastatic GIST (p = 0.001). Two-year, recurrence-free survival (RFS) was 85 and 44 % for primary and recurrent/metastatic disease, respectively, whereas 2-year overall survival (OS) was 97 % for primary and 73 % for recurrent/metastatic GIST. For primary GIST, duration of neoadjuvant therapy >365 days (p = 0.02) was associated with higher risk of recurrence on univariate analysis, whereas none of the clinicopathologic factors impacted OS. For recurrent/metastatic disease, disease progression was associated with a shorter OS (p = 0.001), but no factors were found to impact RFS. Lastly, when examining all patients, KIT mutations (p = 0.03) and multivisceral resection (p = 0.011) predicted shorter RFS.

Conclusions

Neoadjuvant TKIs can be effectively used for the treatment of primary and recurrent/metastatic GIST. While duration of neoadjuvant therapy, KIT mutation status, and the need for multivisceral resection can help to predict higher risk for recurrence, progression on neoadjuvant TKIs can aid in selection of patients with recurrent/metastatic disease for surgical resection.
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Metadata
Title
Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapy for Gastrointestinal Stromal Tumors
Authors
Brian K. Bednarski, MD
Dejka M. Araujo, MD
Min Yi, MD, PhD
Keila E. Torres, MD, PhD
Alexander Lazar, MD, PhD
Jonathan C. Trent, MD, PhD
Janice N. Cormier, MD, MPH
Peter W. T. Pisters, MD
Dina Chelouche Lev, MD
Raphael E. Pollock, MD, PhD
Barry W. Feig, MD
Kelly K. Hunt, MD
Publication date
01-08-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3632-7

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