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Outcomes of Patients Undergoing Surgery for Metastatic GIST
Mihir M. Shah*, Noaman Ali, Kathryn Stackhouse, Hideo Takahashi, Maitham a. Moslim, Sricharan Chalikonda
General Surgery, Cleveland Clinic Foundation, Cleveland Heights, OH
Introduction:
In the era before imatinib, 30% of the patients who presented with metastatic gastrointestinal stromal tumor (GIST) were subjected to surgery with poor overall outcomes. We aim to determine the demographics and role of surgery for patients who present with metastatic GIST at their initial (first) presentation at a single institution.
Methods:
We retrospectively reviewed the electronic medical records of 416 patients with the diagnosis of GIST between August 2009 and July 2013. 26 patients (6.25 %) presented with metastatic GIST at their initial presentation. Only patients who presented for the first time and were diagnosed with metastatic GIST as their initial diagnosis were included in this study. Patients with prior diagnosis of non-metastatic GIST or with any form of prior therapy for non-metastatic GIST were excluded from this study.
Continuous variables were summarized using means, standard deviation and 5-number summaries. Categorical variables were summarized using counts and percentages. All analyses were done using R software (version 3.0.2, Vienna, Austria).
Results:
Patients with metastatic GIST at initial presentation were found to have a median BMI of 27.4 and the median age at diagnosis of metastatic GIST was 62 years. 16 patients (62 %) were men.
25 patients (96 %) received medical therapy. 14 patients (54%) were subjected to surgery. 13 patients (50 %) received both medical therapy and surgery. 17 patients (68 %) had progressive disease and 6 patients (24 %) had stable disease. The median follow-up with us after diagnosis was 26 months (Interquartile range: 12 - 91 months).
10 of 14 patients who underwent surgery had a median post-operative length of stay of 9 days.
In total, 19 patients (73 %) received imatinib, 5 patients (19 %) received imatinib and sunitinib.
Table 1 shows summaries of the continuous variables of interest in the dataset.
Table 2 shows summaries of the categorical variables of interest in the dataset.
Conclusion:
Demographics of patients presenting with metastatic GIST were established. In the current era of imatinib therapy, patients who presented with metastatic GIST, 54 % were subjected to surgery, and 50 % of the patients received both medical and surgical therapy. Overall survival at median follow up of 26 months was 64 %.
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