Analysis of clinical features and prognostic factors of gastrointestinal stromal tumors with hepatic metastasis

HU Xueyang; CHEN Wei; CHEN Wenjun; LI Fanfan

Abstract：Objective To discuss the clinical features and prognostic factors of gastrointestinal stromal tumor( GIST) with he-patic metastasis. Methods From January 2002 to January 2014, 138 patients with recurrent or metstatic GIST were enrolled, among whom 74 cases occurred with hepatic metastasis. According to the recurrent sites, patients were divided into 3 groups:hepatic metasta-sis only group ( n=34) , abdominal metastasis group ( n=64) , and abdominal and hepatic metastasis group ( n=40) . All patients were given imatinib mesylate orally with initial dose of 400 mg per day. Logistic regression model was used to analyze factors affecting short-term efficacy;Kaplan-Meier method was employed to analyze long-term efficacy; prognostic factors were analyed by Cox proportional hazards regression model. Results A total of 135 cases could be evaluated for curative effect. In 74 cases with hepatic metastasis, 11 received CR, 41 received PR, 18 received SD, and 4 received PD. The response rate ( RR) and disease control rate ( DCR) were 70. 3% and 94. 6%, respectively. There were no statistical differences in RR and DCR among the 3 groups ( P>0. 05) . According to the Logistic regression model analysis, simultaneous liver metastasis was the independent factor affecting RR. The median progression-free survival ( PFS) and median overall survival ( OS) of the whole group were 52 months and 66 months, respectively. The 1-, 2-, 3-and 5-year survival rates were 97. 0%, 89. 6%, 82. 3% and 60. 0%, respectively. The median PFS and OS of patients with hepatic me-tastasis were 45 months and 68 months, respectively. The 1-, 2-, 3-and 5-year survival rates were 97. 2%, 92. 5%, 87. 4% and 59. 2%, respectively. The median PFS of hepatic metastasis only group, abdominal metastasis group, and abdominal and hepatic me-tastasis group were 61, 56 and 30 months, respectively. The median OS of the 3 groups were 75, 65 and 63 months, respectively. Ac-cording to the Cox proportional hazards regression model analysis, companying with other organ metastasis and short term efficacy were the independent factors affecting PFS, while companying with other organ metastases and age were the independent factors affecting OS. The main adverse reactions of the three groups were edema, leukopenia and diarrhea, mainly in grade 1-2. There were no statistical differences in adverse reactions among the 3 groups. Conclusion Short term efficacy is not affected by hepatic metastasis in GIST pa-tients taking imatinib mesylate. Extrahepatic lesions, age and response rate are important factors affected the survival of the GIST pa-tients who have hepatic metastasis.