Surgery Prolongs the Survival of Patients with Metastatic, Recurrent, or Unresectable Locally Advanced Gastrointestinal Stromal Tumors Response to Imatinib Mesylate Treatment: A Systematic Review and Meta-analysis

Abstract

Background The role of surgery in patients with metastatic, recurrent or unresectable locally advanced gastrointestinal stromal tumors (GIST) who respond to imatinib mesylate (IM) treatment is still not formally defined. Therefore, we systemically searched and analyzed the available literature to evaluate the oncologic benefits of surgery in this specific population. Methods A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed to identify relevant articles on July 16, 2020. Pooled data analysis was also performed using Review Manager. Results Totally 10 studies including 1188 patients (410 patients in the surgery group and 778 patients in the no surgery group) were included in the final analysis. No significant differences in baseline clinical characteristics were found except that patients in the surgery group were significantly younger (WMD, -5.02, 95% CI, -8.38 to -1.67, P = 0.003). In the overall population, pooled data showed a significant improvement in overall survival (OS) (HR, 0.62; 95% CI, 0.53 to 0.73; P < 0.0001) and progression-free survival (PFS) (HR, 0.57; 95% CI, 0.44 to 0.72; P < 0.0001) with surgery. In the subgroup analysis, the impact of surgery on patient response to IM treatment was further confirmed (OS: HR, 0.67; 95% CI, 0.55 to 0.81; P < 0.0001; PFS: HR, 0.62; 95% CI, 0.46 to 0.82; P = 0.009). Conclusions Surgery prolongs the OS and PFS of patients with metastatic, recurrent, or unresectable locally advanced GIST who respond to IM treatment. Future prospective, multicenter RCTs are warranted.