Neoadjuvant versus adjuvant imatinib in primary localized gastrointestinal stromal tumor

Jiayu Ling; Lishuo Shi; Xingyu Cheng; Yang Fu; Ziqin Lin; Yandong Zhao; Zheqing Li; Jianwei Zhang; Huabin Hu; Yue Cai; Yanhong Deng

doi:10.21037/jgo-22-931

Neoadjuvant versus adjuvant imatinib in primary localized gastrointestinal stromal tumor

J Gastrointest Oncol. 2023 Feb 28;14(1):73-84. doi: 10.21037/jgo-22-931. Epub 2023 Jan 10.

Authors

Jiayu Ling^#^{1

2}, Lishuo Shi^#^{2

3}, Xingyu Cheng^{1

2}, Yang Fu^{1

2}, Ziqin Lin^{1

2}, Yandong Zhao^{2

4}, Zheqing Li^{2

5}, Jianwei Zhang^{1

2}, Huabin Hu^{1

2}, Yue Cai^{1

2}, Yanhong Deng^{1

2}

Affiliations

¹ Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Center for Clinical Research, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ Department of Data Management, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: The effect of neoadjuvant therapy (NAT) with imatinib versus upfront resection (UR) followed by adjuvant therapy (AT) with imatinib on the outcomes of gastrointestinal stromal tumors (GIST) is unknown.

Methods: This is a retrospective study at a high-volume center. All the patients with primary localized GIST were identified in a hospital database from 2007 to 2021. The endpoints included local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), and overall survival (OS). Cox regression was used to perform multivariate survival analyses. The sensitivity analysis was conducted with the inverse probability of treatment weighting (IPTW) method.

Results: A total of 211 patients were included (Group A: UR + AT, n=140; Group B: NAT + resection + AT, n=71). In the entire cohort, 5-year DRFS, LRFS, and OS were 85.6%, 90.7%, and 92.5%, respectively. In the multivariate analysis, better DRFS was linked to NAT, tumor size of 5 cm, and AT. Sixteen patients (11.4%) in Group A and 1 (1.4%) in Group B had distant recurrences after AT discontinuation. The sensitivity analysis by IPTW provided approximately similar results. An interaction effect was observed between NAT and tumor location on DRFS. In non-gastric GISTs, NAT was associated with better DRFS [hazard ratio =0.131, 95% confidence interval (CI): 0.017-0.989, P=0.049], which was not the case in gastric GIST (P=0.08). NAT was not independently associated with LRFS or OS.

Conclusions: When compared to UR + AT, NAT + resection + AT may reduce the risk of distant recurrence in localized GIST and may be especially beneficial for patients with non-gastric GISTs.

Keywords: Gastrointestinal stromal tumors; imatinib mesylate; neoadjuvant therapy; retrospective studies; treatment outcome.