Resection Combined with TKI Therapy for Resectable Liver Metastases of Gastrointestinal Stromal Tumours: Results from Three National Centres in China

Abstract

Objective

To investigate the differences in the efficacy of hepatic resection combined with tyrosine kinase inhibitor (TKI) therapy versus TKI therapy alone and the timing of the TKI therapy and hepatic resection for resectable liver metastases from gastrointestinal stromal tumours (GISTs).

Methods

This was a retrospective review of 43 patients confirmed to have resectable liver metastases from GISTs who received TKI treatment alone or the therapy model of hepatic resection combined with TKIs and were admitted to one of 3 institutions between January 2006 and December 2017.

Results

For all liver metastases patients, the 1-, 3- and 5-year survival rates were 97.67%, 88.98% and 66.46%, respectively. The median overall survival (OS) was 85 months. Patients who underwent hepatic resection combined with TKI therapy had a significantly better OS and a trend towards improved progression-free survival (PFS) than patients who received TKIs alone (P = 0.001, mOS 102 months versus 51 months; P = 0.077, mPFS 42 months versus 30 months). Hepatic resection combined with TKI therapy was the only prognostic factor for long-term survival in the multivariate analysis (HR = 0.198, 95% CI 0.048–0.813, P = 0.025). Compared with patients who underwent hepatic resection combined with postoperative TKIs only, patients who underwent hepatic resection combined with perioperative TKIs had a significantly better PFS (P = 0.032, mPFS 29 months versus 19 months) but did not have a significantly better OS (P = 0.662, mOS 92 months versus 102 months). Resection combined with perioperative TKI therapy was the only prognostic factor for PFS in the multivariate analysis (HR = 0.295, 95% CI 0.101–0.862, P = 0.026).

Conclusions

For patients with resectable liver metastases, hepatic resection combined with TKI therapy was more beneficial in terms of improving prognosis than TKIs alone. In terms of the timing of TKI therapy and hepatic resection, resection combined with perioperative TKIs may prolong PFS more than resection combined with postoperative TKIs only.

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Fig. 1

Abbreviations

GISTs:

Gastrointestinal stromal tumours

TKIs:

Tyrosine kinase inhibitors

RECIST:

Response Evaluation Criteria in Solid Tumours

OS:

Overall survival

PFS:

Progression-free survival

IQR:

Interquartile range

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

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Acknowledgements

Special thanks should go to Dr. Xingjin Wu for critically reading the manuscript and providing her valuable comments.

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All authors have made substantial contributions to the conception of the work or the acquisition, analysis or interpretation of the data for this work, drafted or revised the paper and provided final approval of the version to be published. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Jianqiang Cai or Jianguo Zhou.

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The authors declare that there are no conflicts of interest.

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This study was approved by the Institutional Review Board of the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Sun Yat-sen University Cancer Center and the First Affiliated Hospital of Zhengzhou University. All patients provided written informed consent.

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Chen, Q., Li, C., Yang, H. et al. Resection Combined with TKI Therapy for Resectable Liver Metastases of Gastrointestinal Stromal Tumours: Results from Three National Centres in China. J Gastrointest Surg 24, 1330–1341 (2020). https://doi.org/10.1007/s11605-019-04278-x

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Keywords

  • Gastrointestinal stromal tumours
  • Liver metastasis
  • Hepatic resection combined with TKI therapy