Abstract

Objective: The study aimed to compare effectiveness and safety of thermal ablation and hepatic resection in patients with liver metastases of gastrointestinal stromal tumors (GISTs).

Method: A total of 55 patients (27 in the ablation group and 28 in the surgery group) with liver metastases were included. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan–Meier’s survival estimate curves. Univariate and multivariate regression analyses were carried out to identify potential prognostic factors.

Results: The median OS was 102.0 months in the ablation group and 117.0 months in the surgery group (p = .875). The 1-, 3- and 5-year OS rates were 100%, 88.9% and 74.1% in the ablation group and 92.8%, 82.1% and 78.6% in the surgery group, respectively. The 1-, 3- and 5-year PFS rates were 48.1%, 25.9% and 18.5% in the ablation group and 67.8%, 64.3% and 64.3% in the surgery group, respectively. Multivariate analysis showed that preoperative tyrosine kinase inhibitor (TKI) treatment (progressive disease, PD) (HR, 13.985; 95% CI, 1.791–109.187; p = .012) was the only significant independent prognostic factor for OS. Tumor number (HR, 1.318; 95% CI, 1.021–1.702; p = .034) was identified as an independent predictor for PFS in multivariate analysis. There were fewer postoperative complications (18.5% vs. 78.6%, p = .001) and shorter lengths of hospital stay (8.0 vs. 16.5 days, p = .001) in the ablation group.

Conclusion: Compared with resection, thermal ablation offered comparable OS for liver metastases of GISTs. Furthermore, thermal ablation had the advantages of fewer complications and shorter lengths of hospital stay.

摘要

目的：本研究旨在比较热消融和肝切除术在胃肠道间质瘤（GIST）肝转移患者中的有效性和安全性。

方法：纳入55例肝转移患者（消融组27例，手术组28例）。使用Kaplan–Meier的生存估计曲线评估了总生存（OS）和无进展生存（PFS）。进行单因素和多因素回归分析以鉴定潜在的预后因素。

结果：消融组中位OS为102.0个月，手术组为117.0个月（p  = .875）。消融组的1年，3年和5年OS率分别为100％，88.9％和74.1％，而手术组分别为92.8％，82.1％和78.6％。消融组的1、3和5年PFS发生率分别为48.1％，25.9％和18.5％，而手术组分别为67.8％，64.3％和64.3％。多元分析表明，术前酪氨酸激酶抑制剂（TKI）治疗（进展性疾病，PD）（HR，13.985； 95％CI，1.791–109.187；p  = .012）是OS的唯一重要独立预后因素。肿瘤数（HR，1.318; 95％CI，1.021–1.702; p = .034）被确定为多变量分析中PFS的独立预测因子。 消融组的术后并发症较少（18.5％vs. 78.6％，p  = .001），住院时间较短（8.0 vs. 16.5天，p = .001）。

结论：与切除相比，热消融可为GIST的肝转移提供可比的OS。此外，热消融的优点是并发症少，住院时间短。