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Prognostic Impact of Metastasis Timing in Metastatic Gastrointestinal Stromal Tumors: A Multicenter Retrospective
Kunihiko Kawai1, Tsuyoshi Takahashi1, Ryugo Teranishi1
1Department of Gastroenterological Surgery the University of Osaka, Graduate School of Medicine Suita Osaka Japan.
Background:
Gastrointestinal stromal tumors (GISTs) commonly metastasize to the liver and peritoneum. Metastases may be detected synchronously at the time of initial diagnosis or develop metachronously after curative-intent resection. Nonetheless, the prognostic significance of metastasis timing in advanced GIST remains unclear.
Methods:
We retrospectively analyzed 147 patients with metastatic GIST treated at multiple institutions between 2003 and 2012. The patients were categorized into synchronous (n = 51) and metachronous (n = 96) groups. Clinicopathological characteristics and overall survival (OS) were compared using Kaplan-Meier analysis and Cox proportional hazards models. Among patients with metachronous disease, the outcomes were further evaluated according to the recurrence interval.
Results:
The median OS was significantly shorter in the synchronous group (6.7 years) than in the metachronous group (12.8 years; p = 0.001). Metastasis timing remained an independent prognostic factor in multivariable analysis (hazard ratio 2.36, 95% confidence interval 1.39-4.00; p = 0.001). Among patients with metachronous metastasis, early recurrence within 2 years after surgery was associated with significantly inferior survival compared to late recurrence.
Conclusion:
Metastasis timing was associated with survival in patients with metastatic GIST. Both synchronous presentation and early metachronous recurrence were associated with poorer outcomes.
