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. 2017 Apr;143(4):727-734.
doi: 10.1007/s00432-016-2334-x. Epub 2017 Jan 12.

Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up

Jian-Xian Lin  1 , Qing-Feng Chen  1 , Chao-Hui Zheng  1 , Ping Li  1 , Jian-Wei Xie  1 , Jia-Bin Wang  1 , Jun Lu  1 , Qi-Yue Chen  1 , Long-Long Cao  1 , Mi Lin  1 , Ru-Hong Tu  1 , Chang-Ming Huang  2
Affiliations

Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up

Jian-Xian Lin et al. J Cancer Res Clin Oncol. 2017 Apr.

Abstract

Background: The therapy for gastrointestinal stromal tumors (GIST) has changed significantly since the use of imatinib mesylate (IM). However, the appropriate duration of receiving adjuvant IM for patients with high-risk GIST who underwent R0 resection is still controversial.

Methods: From January 2005 to December 2014, 234 patients who underwent R0 resection and were treated with adjuvant imatinib at our institution were identified from a prospectively collected database. The effect of the medication duration on the long-term outcomes was analyzed.

Results: In this study, 140 cases were male and 94 cases were female, and the mean age was 57.5 ± 11.4 years. The most common site was the stomach (103 cases, 44%), followed by the small intestine (81 cases, 34.6%). The 5 year recurrence-free survival (RFS) rate and overall survival (OS) rate in the whole groups were 76.2 and 83.4%, respectively. The patient's prognosis was improved due to the prolongation of the time of receiving the imatinib treatment (P < 0.05). According to the results of the risk stratification analysis, the outcomes of the moderate-risk patients who received IM adjuvant therapy for 1-year group, 1-3 years group and more than 3 years group showed improvement, but the difference was not statistically significant (P > 0.05). However, in the high-risk patients, the RFS rates of the 1-year group, 1-3-years group, 3-5-years group and more than 5 years group were 36.5, 68.7, 71.2 and 90.8%, respectively, and the OS rates were 36.7, 76.6, 84.0 and 97.4%, respectively (P < 0.001). In addition, linear regression analysis showed that the long-term outcomes of patients with high-risk GIST significantly improved due to prolonged adjuvant IM treatment durations (P < 0.05). The RFS rate of patients receiving IM for more than 5 years was significantly better than those receiving it for less than 5 years. Multivariate COX regression analysis in the patients with high-risk GIST showed that tumor located in small intestine was an independent risk factor, while receiving IM treatment was an independent protective factor for prognosis.

Conclusions: The long-term outcomes of patients with high risk GIST improved due to the prolongation of the IM treatment. To reduce the recurrence and improve the long-term survival, we suggest that patients with high-risk GIST receive imatinib treatment for at least 5 years.

Keywords: Gastrointestinal stromal tumors; Imatinib mesylate; Prognosis.

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Conflict of interest statement

The authors claim no conflict of interest.

Figures

Fig. 1
Fig. 1
The survival curves of moderate- and high-risk patients treated by imatinib. a The recurrence-free survival (RFS) curve. b The overall survival (OS) curve
Fig. 2
Fig. 2
The survival curves of patients according to different durations of IM. a The RFS. b The OS
Fig. 3
Fig. 3
The survival curves of moderate-risk patients with different durations of IM. a The RFS. b The OS
Fig. 4
Fig. 4
The survival curves of high-risk patients with different durations of IM. a The RFS. b The OS
Fig. 5
Fig. 5
Linear regression analyses of different durations and RFS rates of high-risk patients
See this image and copyright information in PMC

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