Document Detail


Surgical outcomes of patients with gastrointestinal stromal tumors in the era of targeted drug therapy.
MedLine Citation:
PMID:  18546049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The discovery of the c-KIT mutation and the advent of targeted drug therapy with imatinib mesylate have revolutionized the management of gastrointestinal stromal tumors (GISTs). The outcome of patients with surgically treated GISTs treated in the era of targeted drug therapy was assessed and factors associated with adverse outcomes determined. MATERIALS AND METHODS: Patients with GISTs requiring surgery at a tertiary care center from 2002 to 2007 were reviewed and prognostic factors determined. RESULTS: Forty patients were surgically treated for GISTs. The median age at presentation was 59 years. The stomach (55%) was the main site of primary disease. The median tumor size was 7 cm. Eleven (28%) patients had metastatic disease at presentation. Surgery was undertaken in all patients with curative intent. Multi-organ resection was required in 10 (25%) patients. Imatinib mesylate was administered postoperatively in 68% of cases. Median follow-up was 24 months. There was a 40% recurrence rate with 63% undergoing repeat surgical resection. The peritoneum and liver were the main sites of recurrent disease. The 5-year disease-specific survival and disease-free survival (DFS) were 65% and 35%, respectively. High mitotic rate (P = 0.017) and tumor size greater than 10 cm (P = 0.009) were the only prognostically significant adverse factors of DFS on multivariate analysis, independent of imatinib mesylate treatment. CONCLUSION: Aggressive surgical treatment and follow-up of GISTs, combined with targeted drug therapy, leads to long-term DFS survival. Tumor recurrence is independently associated with a high tumor mitotic rate and size greater than 10 cm, despite the use of adjuvant targeted drug therapy.
Authors:
Mehrdad Nikfarjam; Eric Kimchi; Serene Shereef; Niraj J Gusani; Yixing Jiang; John Liang; Mandeep Sehmbey; Kevin F Staveley-O'Carroll
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-06-11
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  12     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-22     Completed Date:  2009-02-11     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2023-31     Citation Subset:  IM    
Affiliation:
Department of Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, H070, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA. mnikfarjam@psu.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Chemotherapy, Adjuvant
Cohort Studies
Disease-Free Survival
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Delivery Systems
Female
Follow-Up Studies
Gastrointestinal Stromal Tumors / drug therapy*,  mortality,  pathology,  surgery*
Humans
Immunohistochemistry
Male
Middle Aged
Neoplasm Staging
Piperazines / administration & dosage*
Probability
Proportional Hazards Models
Proto-Oncogene Proteins c-kit / drug effects*,  genetics
Pyrimidines / administration & dosage*
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Piperazines; 0/Pyrimidines; 152459-95-5/imatinib; EC 2.7.10.1/Proto-Oncogene Proteins c-kit

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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