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Annals of Surgical Oncology

, Volume 14, Issue 1, pp 134–142 | Cite as

Outcome of Metastatic GIST in the Era before Tyrosine Kinase Inhibitors

  • Jason S. Gold
  • Sanne M. van der Zwan
  • Mithat Gönen
  • Robert G. Maki
  • Samuel Singer
  • Murray F. Brennan
  • Cristina R. Antonescu
  • Ronald P. DeMatteo
Article

Abstract

Background

Treatment of metastatic GIST with imatinib mesylate results in a 2-year survival of approximately 72%. The outcome of patients with metastatic GIST not treated with tyrosine kinase inhibitors is not well defined.

Methods

One hundred nineteen patients with metastatic GIST diagnosed prior to July 1, 1998 (approximately 2 years prior to the use of imatinib for GIST) were identified from an institutional database of patients with pathologically confirmed GIST. Mutational analysis was performed in cases with available tissue. The log rank test and Cox regression models were used to assess prognostic factors.

Results

Median survival was 19 months with a 41% 2-year survival and a 25% 5-year survival. Resection of metastatic GIST was performed in 81 patients (68%), while 50 (42%) received conventional chemotherapy. Twelve patients (10%) were eventually started on imatinib. Primary tumor size <10 cm, <5 mitoses/50 HPF in the primary tumor, epithelioid morphology, longer disease-free interval, and surgical resection were independent predictors of improved survival on multivariate analysis. Mutational status did not predict outcome. In patients who underwent resection, the 2 year survival was 53%, and negative microscopic margins also independently predicted improved survival.

Conclusions

Treatment with imatinib appears to improve 2-year survival of metastatic GIST by approximately 20% when compared to surgery alone. The combination of imatinib and surgery for the treatment of metastatic GIST therefore warrants investigation.

Keywords

Gastrointestinal stromal tumor GIST Imatinib mesylate Gleevec Surgery 

Notes

Acknowledgments

Supported in part by: PO1 CA 47179 (MFB), ACS MRSG CCE-106841 (CRA), and CA94503 and CA102613 (RPD).

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Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Jason S. Gold
    • 1
  • Sanne M. van der Zwan
    • 1
  • Mithat Gönen
    • 1
  • Robert G. Maki
    • 1
  • Samuel Singer
    • 1
  • Murray F. Brennan
    • 1
  • Cristina R. Antonescu
    • 1
  • Ronald P. DeMatteo
    • 1
    • 2
  1. 1.Departments of Surgery (JSG, SMV, SS, MFB, RPD), Epidemiology and Biostatistics (MG), Medicine (RGM), and Pathology (CRA)Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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