Surgical Management, Survival Outcomes for GIST With Liver Metastasis

Surgical treatment combined with targeted therapy may improve overall survival (OS) and cancer-specific survival (CSS) in patients with gastrointestinal stromal tumors (GISTs) with synchronous liver metastasis (GIST-SLM), according to a validated predictive model developed in China.

Results of the analysis and validation of the developed nomogram were published in Frontiers in Oncology.

Before 2000, patients with metastatic GIST were most often treated with surgical resection or chemotherapy, but response to chemotherapy was less than 10% and the prognosis after surgical resection was poor. The advent of tyrosine kinase inhibitors, including imatinib, has revolutionized the treatment approach for GISTs. However, it remains unknown whether surgical resection with targeted therapy is beneficial for the long-term survival of GIST-SLM.

Researchers sought to investigate the effect of surgical resection, with or without targeted therapy, on survival in GIST-SLM and develop a clinically viable predictive model for OS and CSS. They identified patients in the Surveillance, Epidemiology, and End Results Program database who were diagnosed with GISTs from 2010 to 2019. Propensity score matching (PSM) was used to balance the bias between the surgery and nonsurgery groups.

Kaplan-Meier analysis was undertaken to determine differences in OS and CSS between the surgery and nonsurgery groups. A nomogram to predict 1-, 3-, and 5-year OS and CSS was subsequently developed and evaluated.

After PSM, 228 patients were included in the analysis. Researchers found significant differences in 1-, 3-, and 5-year OS (93.5% vs 84.4%, 73.2% vs 55.3%, and 60.9% vs 36.9%, respectively; P=.014) and CSS (3.5% vs 86.2%, 75.3% vs 57.9%, and 62.6% vs 42.9%, respectively; P=.02) between the two groups.

Importantly, they also found that patients who received surgery combined with targeted therapy benefited from improved OS (96.6% vs 90.9%, 74.9% vs 56.8%, and 61.7% vs 35.5%, respectively; P=.022) and CSS (96.6% vs 92.1%, 77.4% vs 59.2%, and 63.8% vs 42.0%, respectively; P=.023) compared with those who received surgery alone.

The area under the curve was 0.774, 0.737, and 0.741 for OS at 1, 3, and 5 years, respectively, and 0.782, 0.742, and 0.746 for 1-, 3-, and 5-year CSS. In the model, C-index was 0.703 for OS and 0.705 for CSS and showed good consistency.

“Surgical treatment can improve the OS and CSS of patients with GIST-SLM,” study authors concluded, noting that adding targeted therapy may be more favorable for long-term survival. Furthermore, internal validation of their predictive model demonstrates its ability to contribute to clinical management and treatment strategy optimization.