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The efficacy of preoperative imatinib in locally advanced gastrointestinal stromal tumors: A single-center retrospective analysis
Background
Preoperative imatinib has been confirmed as a proper down-staging method for gastrointestinal stromal tumors (GISTs). The study aimed to explore the efficacy of preoperative imatinib in locally advanced GISTs.
Methods
We retrospectively examined all patients who received surgery after preoperative imatinib for GISTs without metastasis and any previous therapy in West China hospital from 2010 to 2020. Clinical, pathological, imaging data were recorded and survival information was gained by regular follow-up.
Results
A total of 36 patients (13 gastric, 8 enteral, and 15 rectal GISTs) were analyzed in this study, including 21 males and 15 females with the median age of 52 years (range:33—72 years). The median duration of preoperative imatinib was 8 months (range:2—24 months) with the initial dose of 400mg. According to RECIST 1.1 criteria, 27 patients achieved partial response (PR), 8 patients for stable disease (SD), and only 1 patient for progression disease (PD). The rate of the mean shrinkage of the maximum diameter of tumors was 35%. All patients underwent surgery with R0 resection and 6 patients received combined organ resection. No patients discontinued imatinib after surgery. Recurrence or metastasis occurred in 9 patients during the postoperative adjuvant period, leading to death in 1 patient. The median follow-up time was 36 months (range:11—126 months), three-year progression-free survival (PFS) was 72.2% whereas three-year overall survival (OS) was 100%. Univariate analysis of PFS showed tumor size >10cm before and after preoperative imatinib (P=0.001 and P=0.003, respectively) and necrosis (P=0.009) were associated with higher risks of recurrence, while multivariate analysis revealed indifference.
Conclusions
For locally advanced GISTs, the use of preoperative imatinib could shrink tumor size, increase the rate of R0 resection and improve prognosis.
Legal entity responsible for the study
The authors.
Funding
This study was funded by the Sichuan Province Science and Technology Support Program (CN) (Grant No. 2020YFS0234, 2020YFS0233) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18034).
Disclosures
All authors have declared no conflicts of interest.
