Factores pronósticos de supervivencia en pacientes con tumores del estroma gastrointestinal en adyuvancia con imatinib

Vilma Fleites-Calvo, Jorge Luis Soriano-García, Mayte Lima-Pérez, Jorge Luis Soriano-Lorenzo, Masiel González-Meisozo, Dunia Morales-Morgado, Carlos Domínguez Álvarez

Texto completo:

PDF

Resumen

Introducción: Los tumores del estroma gastrointestinal son neoplasias raras del aparato gastrointestinal. Un número considerable de casos presenta factores de riesgos que provocan recurrencia temprana de la enfermedad, por tanto, la terapia adyuvante con imatinib en este grupo de pacientes logra aumentar el intervalo libre de enfermedad y la supervivencia global.

Objetivo: Identificar los factores pronósticos que influyen en la supervivencia de pacientes con tumores del estroma gastrointestinal en etapas localizadas en tratamiento adyuvante con imatinib.

Material y Métodos: Se realizó un estudio retrospectivo y observacional en pacientes con diagnóstico de tumores del estroma gastrointestinal atendidos en el Hospital Ameijeiras, que recibieron tratamiento adyuvante con imatinib entre 2003 y 2020. Se evaluó supervivencia por método Kaplan-Meier, y regresión de Cox, para determinar los factores pronósticos independientes de supervivencia.

Resultados: Las tasas de supervivencia libre de enfermedad a 2, 3 y 5 años fueron 84,6 %, 81,2 % y 74,5 %, respectivamente. Las tasas de supervivencia global a 2, 3 y 5 años fueron 96,6 %, 88,6 % y 81,9 %, respectivamente. La edad >60 años, localización tumoral no gástrica, mayor índice mitótico y presencia de márgenes quirúrgicos positivos constituyeron factores pronósticos independientes relacionados con una menor supervivencia.

Conclusiones: Los resultados en términos de supervivencia libre de enfermedad y supervivencia global son similares a los reportados internacionalmente.

Palabras clave

Tumores del estroma gastrointestinal, imatinib, pronóstico, supervivencia, localización tumoral no gástrica.

Referencias

Soriano-Lorenzo J, Lima-Pérez M, Soriano-García J, Zaldívar-Blanco K, Fleites-Calvo V. Tumores del estroma gastrointestinal. An Fac med [Internet]. 2019;80(2):214-21. Disponible en: https://doi.org/10.15381/anales.802.16418

Blay JY, Kang YK, Nashida T, von Mehren M. Gastrointestinal stromal tumours. Nat Rev Dis Primers [Internet]. 2021;18(7):22. Disponible en: https://doi.org/10.1038/s41572-021-00254-5

Von Mehren M, Joensuu H. Gastrointestinal stromal tumors. J Clin Oncol [Internet]. 2018;36(2):136-43. Disponible en: https://doi.org/10.1200/JCO.2017.74.9705

Li GZ, Raut CP. Targeted therapy and personalized medicine in gastrointestinal stromal tumors: drug resistance, mechanisms, and treatment strategies. Onco Targets Ther [Internet]. 2019;12:5123-33 Disponible en: https://doi.org/10.2147/OTT.S180763

Mei L, Du W, Idowu M, von Mehren M, Boikos SA. Advances and challenges on management of gastrointestinal stromal tumor. Front Oncol [Internet]. 2018;8:135. Disponible en: https://doi.org/10.3389/fonc.2018.00135

DeMatteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD. Placebo-controlled randomized trial of adjuvant imatinib mesylate following the resection of localized, primary gastrointestinal stromal tumor (GIST). Lancet [Internet]. 2009; 373(9669):1097-2104. Disponible en: https://doi.org/10.1016/S0140-6736(09)60500-6

DeMatteo RP, Ballman KV, Antonescu CR, Corless C, Kolesnikova V, von Mehren M. Long-term result of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumors (GIST) ACOSOG Z9000 (Alliance) intergroup phase 2 trial. Ann Surg [Internet]. 2013; 258(3):422-29. Disponible en: https://doi.org/10.1097/SLA.0b013e3182a15eb7

Casali PG, Le Cesne A, Poveda A, Kotasek D, Rutkowski P, Hohenberg P, et al. Time to definitive failure to the first tyrosine kinase inhibitor in localized GI stromal tumors treated with imatinib as an adjuvant:a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup randomized trial in collaboration with the Australasian Gastro-Intestinal Trials Group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group and Spanish Group for Research on Sarcoma. J Clin Oncol [Internet]. 2015; 33(36):4276-83. Disponible en: https://doi.org/10.1200/JCO.2015.62.4304

Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schutte J, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA [Internet]. 2012; 307(12):1265-72. Disponible en: https://doi.org/10.1001/jama.2012.347

Joensuu H, Eriksson M, Sundby K, Reichardt A, Hermes B, Schütte J, et al. Survival outcomes associated with 3 years vs 1 year of adjuvant imatinib for patients with high-risk gastrointestinal stromal tumors: an analysis of a randomized clinical trial after 10-year follow-up. JAMA [Internet]. 2020;307(12):1265-72. Disponible en: https://doi.org/10.1001/jamaoncol.2020.2091

Casali PG, Blay JY, Abecassis N, Bajpai J, Bauer S, Biagini R, et al. Gastrointestinal stromal tumors: ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2018;29(Suppl4):iv68-iv78. Disponible en: https://doi.org/10.1016/j.annonc.2021.09.005

NCCN Clinical Practice Guidelines in Oncology. Gastrointestinal stromal Tumor (GISTs). Version 1.2022 [Internet]. EE UU: NCCN; 2022. [Citado 10/01/2022]. Disponible en: http://www.nccn.org/guidelines

Poveda A, García del Muro X, López Guerrero JA, Martínez V, Romero I, Serrano C, et al. GEIS Guidelines for gastrointestinal sarcomas (GIST). Cancer Treat Rev [Internet]. 2017;55:107-19. Disponible en: https://dx.doi.org/10.1016/j.ctrv.2016.11.011

Landi B, Blay JY, Bonvalot S, Breasseur M, Coindre JM, Emile JF, et al. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up (SNFG•, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis [Internet]. 2019;51(9):1223-31. Disponible en: https://doi.org/10.1016/j.dld.2019.07.006

Raut C, Espat J, Maki RG, Araújo DM, Trent J, Williams TF, et al. Efficacy and tolerability of 5-year adjuvant imatinib treatment for patients with resected intermediate or high risk primary gastrointestinal stromal tumor: the PERSIST-5 clinical trial. JAMA Oncol [Internet]. 2018;4(12):e184060. Disponible en: https://doi.org/10.1001/jamaoncol.2018.4060

Rutkowski P, Bylina E, Lugowska I, Teterycz P, Klimczak A, Streb J, et al. Treatment outcome in older patients with advanced gastrointestinal stromal tumors (GIST). J Geriatr Oncol [Internet]. 2018;9(5):520-5. Disponible en: https://doi.org/10.1016/j.jgo.2018.03.009

Kramer K, Knippschild U, Mayer B, Bögelspacher K, Spatz H, Henne-Bruns D, et al. Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST). BMC Cancer [Internet]. 2015;15:57. Disponible en: https://doi.org/10.1186/s12885-015-1054-y

Corless Cl, Ballman KV, Antonescu CR, Kolesnikova V, Maki RG, Pisters PW, et al. Pathologic and molecular features correlate with long-term outcome after adjuvant therapy of resected primary GI stromal tumor: the ACOSOG Z9001 trial. J Clin Oncol [Internet]. 2014;32(15):1563-70. Disponible en: https://doi.org/10.1200/JCO.2013.51.2046

Joensuu H, Eriksson M, Hall KS, Hartmann JT, Pink D, Schütte J. Risk factors for gastrointestinal stromal tumor recurrence in patients treated with adjuvant imatinib. Cancer [Internet]. 2014; 120(15):2325-33. Disponible en: https://doi.org/10.1002/cncr.28669

Zhao R, Wang Y, Huang Y, Cui Y, Xia L, Chen Y, et al. Adjuvant imatinib for patiens wih high risk gastrointestinal stromal tumors: a retrospective cohort study. Sci Rep [Internet]. 2017;7(1):16834. Disponible en: https://doi.org/10.1038/s41598-017-17266-5

Lin JX, Chen QF, Zheng CH, Li P, Xie JW, Wang JB, et al. Is 3-year duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up. J Cancer Res Clin Oncol [Internet]. 2017;143(4):727-34. Disponible en: https://doi.org/10.1007/s00432-016-2334-x

Soriano JL, Lima M, Fleites V, Domínguez C, González M, Fernández LT, et al. Características clínicas y patológicas de pacientes con tumores estromales gastrointestinales en Cuba. Acta Médica. [Internet]. 2021 [Citado 11/1/2022];22(1):e141. Disponible en: http://www.revactamedica.sld.cu/index.php/act/article/view/141/0

Zhang H, Liu Q. Prognostic indicators for gastrointestinal stromal tumors: a review. Transl Oncol [Internet]. 2020;13(10):100812. Disponible en: https://doi.org/10.1016/j.tranon.2020.100812

Zhou Y, Hu W, Chen P, Abe M, Shi L, Tan SY, et al. Ki67 is a biological marker of malignant risk of gastrointestinal stromal tumors. Medicine [Internet]. 2017;96(34):e7911. Disponible en: http://dx.doi.org/10.1097/MD.0000000000007911

Zhao WY, Wang M, Zhang ZZ, Wang CJ, Lin TL, Shen YY. Prognostic value of Ki67 index in gastrointestinal stromal tumor. Int J Clin Exp Pathol. 2015;7(5):2298-304.

Boukovinas I, Kotsakis A, Androulakis N, Aravantinos G, Michalaki V, Christodoulou C, et al. Recurrence-free survival and safety of imatinib in patients with gastrointestinal stromal tumor (GIST) in Grece. Anticancer Res [Internet]. 2020;40(1):435-41. Disponible en: https://doi.org/10.21873/anticanres.13971

Lei C, Zhao B, Wang Q, Ge L, Wang H. Imatinib therapy after resection of high-risk gastrointestinal stromal tumors in Chinese patients: a median follow-up of 48 months. JBUON. 2018;25(2):460-7.

McCarter M, Antonescu CR, Bllman KV, Maki RG, Pister PW, Demetri GD, et al. Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg [Internet]. 2012;215(1):53-9. Disponible en: https://doi.org/10.1016/j.jamcollsurg.2012.05.008

Gronchi A, Bonvalot S, Poveda A, Kotasek D, Rutkwoski P, Hohenberg P, et al. Quality of surgery and outcome in localized gastrointestinal stromal tumors treated within an international intergroup randomized clinical trial of adjuvant imatinib. JAMA Surg [Internet]. 2020; 155(6):e200397. Disponible en: https://doi.org/10.1001/jamasurg.2020.0397

Lu J, Dai Y, Zheng HL, Xie JW, Wang JB, Lin JX, et al. What is the appropriated duration of adjuvant imatinib mesylate treatment for primary gastrointestinal stromal tumors classified according to the strict definition of tumor rupture? Medicine [Internet]. 2019;98(3):e14177. Disponible en: https://doi.org/10.1097/MD.0000000000014177

Joensuu H, Wardelmann E, Sihto H, Eriksson M, Sundby Hall K, Reichardt A. Effect of KIT and PDGFRA mutations on survival in patients with gastrointestinal stromal tumors treated with adjuvant imatinib: an exploratory analysis of a randomized clinical trial. JAMA Oncol [Internet]. 2017; 3(5):602-9. Disponible en: https://doi.org/10.1001/jamaoncol.2016.5751

Vicenzi B, Napolitano A, Fiocco M, Mir O, Rutkowski P, Blay JY, et al. Adjuvant imatinib in GIST patients harboring exon 9 KIT mutations: results from a multi-institutional European retrospective study. Clin Cancer Res [Internet]. 2022;14;28(8):1672-9. Disponible en: https://doi.org/10.1158/1078-0432.CCR-21-1665.



Añadir comentario

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.