Survival outcome and impact of delayed imatinib therapy in gastric gastrointestinal stromal tumors.

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2025-04-03 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1569677

R Jansuwan, S Samphao, Wongsakorn Chaochankit

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引用次数: 0

Abstract

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with the stomach being the predominant site. Surgical resection is the primary treatment for localized disease, but recurrence remains a concern, particularly in high-risk patients. Tyrosine kinase inhibitors (TKIs), such as imatinib, improve disease-free survival (DFS), yet their accessibility is often limited in resource-constrained settings.

Methods: This retrospective cohort study included gastric GIST patients who underwent surgical resection between 2015 and 2020 at a tertiary referral center. DFS and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox proportional hazards regression.

Results: A total of 86 patients were included, with 40 (46%) classified as high-risk. The 5-year DFS was significantly lower in high-risk patients (40% vs. 95.7%, p < 0.001). Imatinib therapy group was associated with worse DFS in high-risk patients (p = 0.003), likely due to delayed initiation after recurrence rather than adjuvant use. Significant predictors of poor DFS included smoking (p < 0.001), prolonged operative time (p = 0.034), and advanced tumor stage (p < 0.001).

Conclusion: Delayed imatinib therapy negatively impacts DFS in high-risk gastric GIST patients, highlighting the need for improved access to early TKI treatment. Additionally, smoking cessation and optimized perioperative management may enhance survival outcomes. Addressing modifiable risk factors and ensuring timely posoperative treatment could improve prognosis in this population.

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胃肠间质瘤延迟伊马替尼治疗的生存结局和影响。

背景：胃肠道间质瘤（gist）是最常见的胃肠道间质肿瘤，以胃为主要部位。手术切除是局部疾病的主要治疗方法，但复发仍然是一个问题，特别是在高危患者中。酪氨酸激酶抑制剂（TKIs），如伊马替尼，可以改善无病生存（DFS），但在资源受限的环境下，它们的可及性往往受到限制。方法：这项回顾性队列研究纳入了2015年至2020年在三级转诊中心接受手术切除的胃间质瘤间质瘤患者。采用Kaplan-Meier曲线和Cox比例风险回归分析DFS和总生存期（OS）。结果：共纳入86例患者，其中40例（46%）为高危患者。高危患者的5年DFS显著降低（40% vs. 95.7%, p p = 0.003），可能是由于复发后延迟启动而不是辅助使用。不良DFS的显著预测因素包括吸烟（p p = 0.034）和肿瘤分期(p)。结论：延迟伊马替尼治疗会对高危胃间质瘤患者的DFS产生负面影响，突出了改善早期TKI治疗的必要性。此外，戒烟和优化围手术期管理可以提高生存结果。解决可改变的危险因素并确保及时的术后治疗可改善该人群的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.