Survivalanalysis For Gastrointestinal Stromal Tumor Patients With Liver Metastases

ObjectiveUp to 50% of gastrointestinal stromal tumor(GIST)patients will have metastatic disease.The most commonly involving sites include liver,which affecting the prognosis of patients.The treatment process for patients with liver metastasis of GIST is still controversial,in order to investigate whether the curative efficacy of hepatectomy combined with tyrosine kinase inhibitor(TKI)treatment is better than TKI treatment alone.To explore whether neoadjuvant therapy can delay its progress and extend survival time in patients with resectable liver metastases from GIST.MethodsWe conducted a retrospective analysis on 38 patients with gastrointestinal stromal tumor liver metastasis who were followed up in our hospital from May 2010 to February 2020 and received hepatectomy combined with TKI treatment or TKI treatment alone.Overall survival(OS)and Progression-free survival(PFS)from start of initial TKI and from time of surgery was determined,then Kaplan Meier survival estimate and Coxproportional hazards regression model analysis were used.ResultsThe 1,3,5-year survival rates of all patients with hepatic metastasis were 94.70%,82.30% and 78.20%,respectively.Patients who received TKI treatment combined with hepatectomy had better OS and PFS than those who received TKI therapy alone(P=0.048,median OS was not reached;P=0.013,median PFS 48 months vs 19 months).In multivariate analysis,the combined treatment of hepatectomy with TKI was the only prognostic indicator for long-term survival(HR = 0.193,95% CI 0.039-0.953,P=0.043);the primary tumor site was an independent predictor for progression-free survival.Compared with the patients whose location of primary tumor was non-gastric,patients whose tumor arising from stomach had a lower risk of disease progression(HR = 3.256,95% CI 1.284-8.255,P=0.013).However,there're no remarkable differences in OS and PFS between patients who underwent hepatectomy combined with neoadjuvant therapy and patients undergoing hepatic resection combined with adjuvant therapy(P=0.920;P=0.064).ConclusionsFor GIST patients with liver metastasis,compared with patients who received TKI treatment only,hepatectomy combined with TKI treatment was more conducive to improve the prognosis of patients.For patients whose liver metastases could be resected,in terms of the perioperativetreatment,there seemed to be no significant difference in prognosis between the groups with and without neoadjuvant therapy.