Niki Stavrou, Nikolaos Memos, Charalampos Filippatos, Theodoros N Sergentanis, Flora Zagouri, Maria Gavriatopoulou, Ioannis Ntanasis-Stathopoulos
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引用次数: 0
Abstract
Introduction: Metastatic and recurrent gastrointestinal stromal tumors (GISTs) present challenging clinical management. Imatinib is the standard first-line therapy, improving survival and reducing tumor burden in the neoadjuvant use, facilitating surgical intervention. This systematic review and meta-analysis assessed the efficacy of neoadjuvant imatinib in metastatic/recurrent GISTs, highlighting its potential to enhance surgical outcomes and overall patient management.
Methods: A systematic search was conducted in PubMed, Embase and Scopus (end-of-search: February 13, 2025) for records on neoadjuvant imatinib therapy in recurrent/metastatic GISTs. Pooled proportions and 95% confidence intervals were calculated with common-effect and random-effects models. Subgroup and meta-regression analysis were performed, addressing heterogeneity and examining any potential association between the factors that varied and the outcomes reported. The present meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Results: The search identified 957 articles, and 14 were analyzed. The meta-analysis of proportions indicated that 2-year and 5-year PFS were 76% (95% CI 58-88%) and 43% (95% CI 17-74%), respectively, while 2-year and 5-year OS were 84% (95% CI 78-89%) and 60% (95% CI 51-68%), respectively. The pooled R0 resection rate was 82% (95% CI 64-92%), associated positively with that of radiological partial response (PR) (β = 3.92, p < 0.001). Further meta-regression analysis yielded no significant association with preoperative imatinib duration.
Conclusion: The present meta-analysis of trials and studies on metastatic or recurrent GISTs highlights key insights into post-surgery patient outcomes following neoadjuvant treatment with imatinib. Pooled effect estimates revealed promising 2-year and 5-year PFS rates of 76% and 43%, respectively, and 2-year and 5-year OS rates of 84% and 60%, respectively. Furthermore, the high pooled R0 resection rate of 82% emphasizes a substantial surgical efficacy in this population, while it was significantly correlated with successful R0 resections in patients with favorable outcomes.
转移性和复发性胃肠道间质瘤（gist）目前具有挑战性的临床管理。伊马替尼是标准的一线治疗药物，在新辅助使用中提高了生存率，减轻了肿瘤负担，便于手术干预。本系统综述和荟萃分析评估了新辅助伊马替尼在转移性/复发性gist中的疗效，强调了其提高手术结果和整体患者管理的潜力。方法：系统检索PubMed， Embase和Scopus（检索结束时间：2025年2月13日），检索复发/转移性gist的新辅助伊马替尼治疗记录。用共同效应和随机效应模型计算合并比例和95%置信区间。进行亚组和元回归分析，处理异质性并检查变化因素与报告结果之间的任何潜在关联。本荟萃分析是按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行的。结果：检索到957篇文献，分析了14篇。比例荟萃分析显示，2年和5年的PFS分别为76% （95% CI 58-88%）和43% (95% CI 17-74%)，而2年和5年的OS分别为84% （95% CI 78-89%）和60% （95% CI 51-68%）。总R0切除率为82% (95% CI 64-92%)，与放射学部分缓解（PR）呈正相关（β = 3.92, p）。结论：目前对转移性或复发性gist的试验和研究的荟萃分析强调了伊马替尼新辅助治疗后患者预后的关键见解。综合效应估计显示，2年和5年的PFS分别为76%和43%，2年和5年的OS分别为84%和60%。此外，82%的总R0切除率强调了该人群的手术疗效，同时与R0切除成功且预后良好的患者显著相关。
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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