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Ann Surg Oncol (2014) 21:24992505 DOI 10.1245/s10434-014-3632-7
ORIGINAL ARTICLE BONE AND SOFT TISSUE SARCOMAS
Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapyfor Gastrointestinal Stromal Tumors
Brian K. Bednarski, MD1, Dejka M. Araujo, MD2, Min Yi, MD, PhD1, Keila E. Torres, MD, PhD1,Alexander Lazar, MD, PhD3, Jonathan C. Trent, MD, PhD5, Janice N. Cormier, MD, MPH1, Peter W. T. Pisters, MD1, Dina Chelouche Lev, MD4, Raphael E. Pollock, MD, PhD6, Barry W. Feig, MD1, and Kelly K. Hunt, MD1
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; 2Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; 3Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; 4Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX; 5Department of Medicine, The University of Miami, Miami, FL; 6Department of Surgical Oncology, The Ohio State University, Columbus, OH
ABSTRACTBackground. Management of gastrointestinal stromal tumors (GISTs) has been transformed with tyrosine kinase inhibitors (TKIs). While data on optimal duration of adjuvant imatinib remains elusive, guidelines for administration of neoadjuvant TKIs remain unknown.Methods. Under an institutional review board-approved protocol, patients at our institution with a diagnosis of GIST treated with neoadjuvant TKIs and surgical resection were identied. Clinical and pathologic characteristics were obtained from medical records.
Results. Ninety-three patients underwent surgical resection after neoadjuvant TKI therapy; 41 had primary and 52 had recurrent/metastatic GIST. Median follow-up was2.4 years. Median duration of neoadjuvant therapy was 315 (range 31,611) days for primary and 537 (range 43,257) days for recurrent/metastatic GIST (p = 0.001). Two-year, recurrence-free survival (RFS) was 85 and 44 % for primary and recurrent/metastatic disease, respectively, whereas 2-year overall survival (OS) was 97 % for primary and 73 % for recurrent/metastatic GIST. For primary
GIST, duration of neoadjuvant therapy [365 days (p = 0.02) was associated with higher risk of recurrence on univariate analysis, whereas none of the clinicopathologic factors impacted OS. For recurrent/metastatic disease, disease progression was associated with a shorter OS (p = 0.001), but no factors were found to impact RFS. Lastly, when examining all patients, KIT mutations (p = 0.03) and multivisceral resection (p = 0.011) predicted shorter RFS.
Conclusions. Neoadjuvant TKIs can...