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Aggressive resection does not improve EFS in wild-type gastrointestinal stromal tumors
Most patients with wild-type gastrointestinal stromal tumors who underwent extensive and serial resections survived with disease progression and no improvement to EFS, according to study data recently published in the Journal of Clinical Oncology.
“The potential benefits of surgery must be tempered by the long-term morbidity of extensive resections in a young population. This is especially true for a disease that may persist for decades before recurrence or progression,” Christopher B. Weldon, MD, PhD, of the department of surgery at Boston Children’s Hospital, and colleagues wrote. “Data supporting guidelines for the surgical management of [wild-type gastrointestinal stromal tumors] are lacking. In particular, the effect of aggressive surgical resection and serial resections on EFS has not been previously investigated.
Weldon and colleagues reviewed data for 76 patients (76% female) who underwent tumor resection at the National Cancer Institute’s wild-type gastrointestinal stromal tumor clinic, which opened in 2008. Researchers used Cox proportional hazards modeling and the Kaplan-Meier method to evaluate the association between resection and EFS.
The patients’ median age at diagnosis was 21 years, and 47% of patients (n = 36) were aged less than 18 years when they were diagnosed.
Sixty-two percent of patients presented with local disease (n = 47). The majority of local disease sites were in the stomach (83%; n = 63), followed by the small intestine (13%; n = 10). Twenty-six percent of patients had metastatic disease at initial diagnosis (n = 20). Five patients (6%) died after being enrolled in the study in 2008. Median follow-up was 4.1 years.
Mean overall EFS was 72.6% at one year, and fell steadily in following years: 57.6% at two years, 23.7% at five years and 16.3% at 10 years. Patients with metastatic disease faced a greater hazard for disease progression or recurrence (adjusted HR = 2.3; 95% CI, 1-5.1), as did those with more than 5 mitoses per 50 high-power fields (adjusted HR = 2.5; 95% CI, 0.4-2.2).
Researchers found no association between EFS and type of gastric resection (P = .67), while repeated resection was significantly associated with poorer EFS (P < .01).
Weldon and colleagues wrote that the data indicated that surgeons should avoid formal anatomic and repeated resections when possible.
“Over the follow-up period of this cohort, we report a low mortality and high likelihood of disease progression or recurrence, even after extensive resections,” the researchers wrote. “Among patients with wild-type gastrointestinal stromal tumors, disease course depends more on mitotic rate and preexisting metastases than on extent of surgical resection. Overall EFS is low, regardless of resection margin status.” – by Andy Polhamus
Disclosure: Weldon reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures.