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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2023

01-12-2023 | Gastrointestinal Stromal Tumor | Systematic Review

Liver resection for metastatic GIST tumor improves survival in the era of tyrosine kinase inhibitors: a systematic review and meta-analysis

Authors: Arash Rahimi-Ardabily, Sanjana Murdande, Michael Dong, Katie W. Gu, Brianna Zhang, Kendall Miller, Krist Aploks, Xiang Da Dong

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

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Abstract

Introduction

Survival for gastrointestinal stromal tumor (GIST) has been increasing over the years after the introduction of tyrosine kinase inhibitors. However, the role of metastasectomy for GIST is still controversial. Patients are currently treated with imatinib or sunitinib in case of imatinib failures as optimal medical therapy for metastatic GIST.

Methods

The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall survival following liver resection ± tyrosine kinase inhibitor treatment for metastatic GIST was compared to treatment with tyrosine kinase inhibitors alone.

Results

Eleven studies including both randomized control trials and retrospective cohort studies were included in the final analysis with a total of 988 patients. Seven studies encompassed data on 556 patients with isolated liver metastases (219 surgery ± drug groups and 337 drug-only groups) were included. Overall survival was significantly improved in patients undergoing liver resection ± drug therapy in comparison to drug therapy alone. [HR (95%CI) = 2.10 (1.58, 2.79); p<0.00001]. Subgroup analysis showed that patients also had improved progression free survival based on 4 studies. [HR (95%CI) = 1.92 (1.43, 2.56); p<0.00001]. In case of concurrent liver and peritoneal metastases, patients showed improved overall survival with aggressive surgical approaches based on 10 studies. [HR (95%CI) = 1.90 (1.56, 2.31); p<0.00001].

Conclusion

This meta-analysis found that liver resection for patients with metastatic GIST regardless of peritoneal metastases improved progression free and overall survival in conjunction with tyrosine kinase inhibitors as compared with medical therapy alone. Furthermore, liver resections did not have any immediate detrimental impact on survival in the group of patients selected.
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Literature
1.
Mazur MT, Clark HB (1983) Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol 7(6):507–519PubMedCrossRef
2.
Miettinen M, Virolainen M, Maarit SR (1995) Gastrointestinal stromal tumors—value of CD34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol 19(2):207–216PubMedCrossRef
3.
Hirota S, Isozaki K, Moriyama Y et al (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Sci 279(5350):577–580CrossRef
4.
Kindblom LG, Remotti HE, Aldenborg F et al (1998) Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 152(5):1259–1269PubMedPubMedCentral
5.
Corless CL, Barnett CM, Heinrich MC (2011) Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer 11(12):865–878PubMedCrossRef
6.
Nishida T, Hirota S, Taniguchi M et al (1998) Familial gastrointestinal stromal tumours with germline mutation of the KIT gene. Nat Genet 19:323–324PubMedCrossRef
7.
Nakahara M, Isozaki K, Hirota S et al (1998) A novel gain-of-function mutation of c-kit gene in gastrointestinal stromal tumors. Gastroenterol 115(5):1090–1095CrossRef
8.
Rubin BP, Singer S, Tsao C et al (2001) KIT activation is a ubiquitous feature of gastrointestinal stromal tumors. Cancer Res 61(22):8118–8121PubMed
9.
Heinrich MC, Corless CL, Duensing A et al (2003) PDGFRA activating mutations in gastrointestinal stromal tumors. Sci 299(5607):708–710CrossRef
10.
11.
Emory TS, Sobin LH, Lukes L et al (1999) Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 23(1):82–87PubMedCrossRef
12.
DeMatteo RP, Lewis JJ, Leung D et al (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231(1):51–58PubMedPubMedCentralCrossRef
13.
Joensuu H, Roberts PJ, Sarlomo-Rikala M et al (2001) Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344(14):1052–1056PubMedCrossRef
14.
15.
Blay JY, Le Cesne A, Ray-Coquard I et al (2007) Prospective multicentric randomized phase III study of imatinib in patients with advanced gastrointestinal stromal tumors comparing interruption versus continuation of treatment beyond 1 year: the French Sarcoma Group. J Clin Oncol 25(9):1107–1113PubMedCrossRef
16.
Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347(7):472–480PubMedCrossRef
17.
Le Cesne A, Ray-Coquard I, Bui BN et al (2010) Discontinuation of imatinib in patients with advanced gastrointestinal stromal tumours after 3 years of treatment: an open-label multicentre randomised phase 3 trial. Lancet Oncol 11(10):942–949PubMedCrossRef
18.
Demetri GD, van Oosterom AT, Garrett CR et al (2006) Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet 368(9544):1329–1338PubMedCrossRef
19.
Gronchi A, Fiore M, Miselli F et al (2007) Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg 245(3):341–346PubMedPubMedCentralCrossRef
20.
DeMatteo RP, Maki RG, Singer S et al (2007) Results of tyrosine kinase inhibitor therapy followed by surgical resection for metastatic gastrointestinal stromal tumor. Ann Surg 245(3):347–352PubMedPubMedCentralCrossRef
21.
Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 4. John Wiley & Sons, England
22.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341PubMedCrossRef
23.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRef
24.
Ducimetiere F, Lurkin A, Ranchere-Vince D et al (2011) Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One 6(8):e20294PubMedPubMedCentralCrossRef
25.
Xia L, Zhang MM, Ji L et al (2010) Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors. Surg Today 40(10):936–942PubMedCrossRef
26.
Du CY, Zhou Y, Song C et al (2014) Is there a role of surgery in patients with recurrent or metastatic gastrointestinal stromal tumours responding to imatinib: a prospective randomised trial in China. Eur J Cancer 50(10):1772–1778PubMedCrossRef
27.
Kanda T, Masuzawa T, Hirai T, Ikawa O, Takagane A, Hata Y, Ojima H, Sodeyama H, Mochizuki I, Ishikawa T, Kagimura T, Nishida T (2017) Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese study group on GIST. Jpn J Clin Oncol 47:369–372PubMed
28.
Shi YN, Li Y, Wang LP et al (2017) Gastrointestinal stromal tumor (GIST) with liver metastases: an 18-year experience from the GIST cooperation group in North China. Med 96(46):e8240CrossRef
29.
Sato S, Tsujinaka T, Masuzawa T et al (2016) Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki Gist Registry. Surg Today 47(1):58–64PubMedCrossRef
30.
Qiu HB, Zhou ZG, Feng XY, Liu XC, Guo J, Ma MZ, Chen YB, Sun XW, Zhou ZW (2018) Advanced gastrointestinal stromal tumor patients benefit from palliative surgery after tyrosine kinase inhibitors therapy. Med 97(2):e9097CrossRef
31.
Xiao B, Peng J, Tang J et al (2018) Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res 10:6121–6127PubMedPubMedCentralCrossRef
32.
Chang SC, Liao CH, Wang SY et al (2015) Feasibility and timing of cytoreduction surgery in advanced (metastatic or recurrent) gastrointestinal stromal tumors during the era of Imatinib. Med 94(24):e1014CrossRef
33.
Zaydfudim V, Okuno SH, Que FG et al (2012) Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res 177(2):248–254PubMedCrossRef
34.
Sutton TL, Walker BS, Billingsley KG et al (2022) Hepatic metastases in gastrointestinal stromal tumors: oncologic outcomes with curative-intent hepatectomy, resection of treatment-resistant disease, and tyrosine kinase inhibitor therapy alone. HPB 24:986–993PubMedCrossRef
35.
36.
Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33(5):459–465PubMedCrossRef
37.
Raut CP, Ashley SW (2008) How I do it: surgical management of gastrointestinal stromal tumors. J Gastrointest Surg 12(9):1592–1599PubMedCrossRef
38.
Blanke CD, Eisenberg BL, Heinrich MC (2001) Gastrointestinal stromal tumors. Curr Treat Options in Oncol 2(6):485–491CrossRef
39.
Van Glabbeke M, Verweij J, Casali PG, Le Cesne A, Hohenberger P, Ray-Coquard I, Schlemmer M, van Oosterom AT, Goldstein D, Sciot R, Hogendoorn PC, Brown M, Bertulli R, Judson IR (2005) Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study. J Clin Oncol 23(24):5795–5804PubMedCrossRef
40.
Bonvalot S, Eldweny H, Pechoux CL et al (2006) Impact of surgery on advanced gastrointestinal stromal tumors (GIST) in the imatinib era. Ann Surg Oncol 13(12):1596–1603PubMedCrossRef
41.
Raut CP, Posner M, Desai J et al (2006) Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. J Clin Oncol 24(15):2325–2331PubMedCrossRef
42.
Rutkowski P, Nowecki Z, Nyckowski P et al (2006) Surgical treatment of patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) during therapy with imatinib mesylate. J Surg Oncol 93(4):304–311PubMedCrossRef
43.
Andtbacka RH, Ng CS, Scaife CL et al (2007) Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol 14(1):14–24PubMedCrossRef
44.
Von Mehren M, Joensuu H (2018) Gastrointestinal stromal tumors. J Clin Oncol 36(2):136–143CrossRef
45.
Antonescu CR (2008) Targeted therapy of cancer: new roles for pathologists in identifying GISTs and other sarcomas. Mod Pathol 21(Suppl 2):S31–S36PubMedCrossRef
46.
47.
Verweij J (2012) Adjuvant treatment of gastrointestinal stromal tumor: the proof, the pro, and the practice. Am Soc Clin Oncol Educ Book 32:659–662CrossRef
48.
Bümming P, Andersson J, Meis-Kindblom JM, Klingenstierna H, Engström K, Stierner U, Wängberg B, Jansson S, Ahlman H, Kindblom LG, Nilsson B (2003) Neoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients. Br J Cancer 89(3):460–464PubMedPubMedCentralCrossRef
Metadata
Title
Liver resection for metastatic GIST tumor improves survival in the era of tyrosine kinase inhibitors: a systematic review and meta-analysis
Authors
Arash Rahimi-Ardabily
Sanjana Murdande
Michael Dong
Katie W. Gu
Brianna Zhang
Kendall Miller
Krist Aploks
Xiang Da Dong
Publication date
01-12-2023
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-023-03052-7

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