2005 Abstracts: Outcome Following Aggressive Surgical Therapy for Gastrointestinal Stromal Tumor
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Outcome Following Aggressive Surgical Therapy for Gastrointestinal Stromal Tumor
Maneesh Gupta, Brett C. Sheppard, Christopher L. Corless, Charles D. Blanke, Kevin G. Billingsley, Oregon Health and Science University, Portland, OR
INTRODUCTION: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. We have pursued an approach of aggressive resection for patients with this disease, including multivisceral resection when indicated. The aim of this study is to report the outcome and prognostic factors associated with this surgical approach.
METHODS: Study subjects were identified using the Pathology database at our institution for the period 1/1992 to 3/2004. All patients underwent resection. Patients with metastases underwent resection of the primary tumor or resection of all metabolically active disease indicated on Positron Emission Tomographic Scan (PET). Medical records were retrospectively reviewed. We calculated survival using the Kaplan Meier Method. Univariate and multivariate analysis of prognostic factors was performed using log rank analysis and the Cox Proportional Hazards model. RESULTS:Thirty four patients were found to be c-kit positive and met study criteria. 50% of the patients were male. The median age was 59 years(range 24-84). 25(74%) patients had regional disease and the remainder had metastases. Tumor arose in the stomach in 20 (59%) patients, duodenum in 7(21%)patients, and a variety of other sites in the remainder.21(62%) patients underwent single organ resection, 13(38%)underwent multivisceral resection. The median survival for all patients was 58 months at a median followup of 11 months. Median survival was 25.9 months for patients requiring multivisceral (MV) resection. Single organ resection patients did not reach median survival. 8 patients (4 with metastases, 4 with regional disease) received imatinib mesylate. Independent predictors of poor survival included: incomplete resection, metastatic disease, high mitotic index, and need for multivisceral resection. Tumor size, microscopically positive margins, and imatinib therapy were not independent predictors of survival. CONCLUSIONS: Extended survival is possible following complete resection of GIST, even in cases in which multivisceral resection is necessary. However, biologic factors including mitotic index, and metastases at surgery remain the primary determinants of survival. Additional survival following resection will likely come from the introduction of molecular targeted therapy in the adjuvant setting.
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