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Observational Study
. 2019 Jan;98(3):e14177.
doi: 10.1097/MD.0000000000014177.

What is the appropriate duration of adjuvant imatinib mesylate treatment for primary gastrointestinal stromal tumors classified according to the strict definition of tumor rupture?

Jun Lu  1   2   3 , Yun Dai  1   2   3 , Hua-Long Zheng  1   2   3 , Jian-Wei Xie  1   2   3 , Jia-Bin Wang  1   2   3 , Jian-Xian Lin  1   2   3 , Qi-Yue Chen  1   2   3 , Long-Long Cao  1   2   3 , Mi Lin  1   2   3 , Ru-Hong Tu  1   2   3 , Ze-Ning Huang  1   2   3 , Ju-Li Lin  1   2   3 , Ping Li  1   2   3 , Chang-Ming Huang  1   2   3 , Chao-Hui Zheng  1   2   3
Affiliations
Observational Study

What is the appropriate duration of adjuvant imatinib mesylate treatment for primary gastrointestinal stromal tumors classified according to the strict definition of tumor rupture?

Jun Lu et al. Medicine (Baltimore). 2019 Jan.

Abstract

In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature; however, "tumor rupture" is inconsistently defined, and its prognostic value remains controversial.Six hundred ninety-one patients undergoing surgery for primary nonmetastatic GISTs from 2003 to 2015 at our institution were enrolled. The strict definitions of "tumor rupture" according to the Kinki GIST Study Group (KGSG) were used.The median follow-up time was 64 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in the entire group were 79.3% and 84.1%, respectively. According to the KGSG's definition, tumor rupture occurred only in 24 (3.5%) of 691 patients. For all 691 patients, multivariable analysis showed that tumor rupture, according to KGSG's definition, is one of the independently prognostic factors for both RFS and OS. Twenty-four patients with tumor rupture were further analyzed. Receiving IM for more than 3 years was significantly associated with improved RFS and OS in GISTs patients with tumor rupture.Tumor rupture according to KGSG's definition was an independent predictive factor associated with GIST patient prognosis. More importantly, for GISTs with tumor rupture according to the KGSG's strict definition, receiving IM treatment for ≥3 years should be considered.

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Conflict of interest statement

The authors have no conflicts of interest to disclose

Figures

Figure 1
Figure 1
Recurrence-free (A) and overall (B) survivals after resection of GISTs in relation to tumor integrity. Tumor integrity was defined by KGSG. GIST = gastrointestinal stromal tumors, KGSG = Kinki GIST Study Group.
Figure 2
Figure 2
Recurrence-free (A) and overall (B) survivals after surgery for 24 patients with tumor rupture according to the KGSG definition, grouped by risk classification. KGSG = Kinki GIST Study Group.
Figure 3
Figure 3
Recurrence-free (A) and overall (B) survivals after surgery for 24 patients with tumor rupture according to the KGSG definition, grouped by different durations of IM. KGSG = Kinki GIST Study Group, IM = imatinib.
See this image and copyright information in PMC

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