关键词:
Cytoreductive surgery
Gastrointestinal stromal tumors
Peritoneal neoplasms
Stomach neoplasms
Tyrosine kinase inhibitors
摘要:
Objective To evaluate the efficacy of cytoreductive surgery (CRS) combined with tyrosine kinase inhibitor(TKI) for the treatment of recurrent and metastatic gastrointestinal stromal tumor(GIST) and to identify the prognostic factors. Methods This is a retrospective cohort study. A total of 89 patients diagnosed with recurrent and/or metastatic GIST at the Department of General Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University from December 2007 to August 2024 were included. Among them,67 were male and 22 were female,with an age of (56.0±11.9)years (range: 26 to 79 years). Patients were divided into two groups based on whether CRS was performed: the CRS combined with TKI therapy group (51 patients) and the TKI therapy alone group(38 patients). Clinical and pathological data,as well as prognostic data,were compared between groups using independent sample t-test,Wilcoxon rank-sum test, χ2 test,or Fisher′s exact test. Cox proportional hazards regression model was used for prognostic factor analysis. Results The CRS combined with TKI therapy group demonstrated superior median overall survival compared to the TKI therapy alone group (102.0 months vs. 65.5 months,P<0.05),with benefits remaining stable after inverse probability weighting (IPTW). For patients with newly diagnosed recurrence and/or metastasis,upfront CRS combined with imatinib showed improved progression-free survival(PFS) compared to imatinib alone (67.0 months vs. 24.0 months,P<0.05). However,following first-line imatinib failure,there was no significant difference in PFS between CRS combined with TKI therapy and TKI therapy alone (P=0.330). Among the 51 patients who underwent CRS,47 patients (74.6%) achieved complete cytoreduction (CC0/1). The incidence of Clavien-Dindo grade Ⅲ to Ⅳ complications was 17.5%(11/63),with no perioperative mortality. Survival analysis revealed that the CC0/1 group had superior median PFS time(22.0 months (95%CI: 18.0 to 67.0 months) vs. 13.0 months (95%