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Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis.

Zhi X, Jiang B, Yu J, Røe OD, Qin J, Ni Q, Sun L, Xu M, Zhu J, Ma L - Sci Rep (2016)

Bottom Line: Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128-2.258; I(2) = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608-3.363; I(2) = 60.8%, P value = 0.013).The level of evidence achieved in this study was "moderate" for DFS and "low" for OS.In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.

ABSTRACT
The impact and management of microscopically positive margins in gastrointestinal stromal tumors (GISTs) remain unclear. The aim of this study is to estimate the prognostic value of surgical margins for disease-free survival (DFS) and overall survival (OS) in patients with primary GISTs. Twelve studies with 1985 GIST patients were included. The overall recurrence rate in R1 resection and R0 resection group was 0.364 (95% CI 0.299-0.429) and 0.296 (95% CI 0.161-0.430), respectively. Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128-2.258; I(2) = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608-3.363; I(2) = 60.8%, P value = 0.013). Importantly, subgroup analysis revealed that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. (HR 1.308, 95% CI 0.583-2.935; I(2) = 53.2%, P value = 0.074). The level of evidence achieved in this study was "moderate" for DFS and "low" for OS. In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the study selection.
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f1: Flow chart of the study selection.

Mentions: The initial and updated searches together identified 427 records. Upon further review, 19 articles evaluating the prognostic value of surgical margins in patients with primary GISTs were considered eligible. Of the 19 articles, 2 were excluded due to the insufficient reported data for the estimation of HR, 3 were excluded because they put R1 resection and R2 resection together, and 2 were excluded due to the small sample size (there are only 2 cases with R1 margin in both studies)1718. Finally, a total of 12 studies141516192021222324252627 were included in this meta-analysis. Literatures screening process was shown in Fig. 1.


Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis.

Zhi X, Jiang B, Yu J, Røe OD, Qin J, Ni Q, Sun L, Xu M, Zhu J, Ma L - Sci Rep (2016)

Flow chart of the study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759596&req=5

f1: Flow chart of the study selection.
Mentions: The initial and updated searches together identified 427 records. Upon further review, 19 articles evaluating the prognostic value of surgical margins in patients with primary GISTs were considered eligible. Of the 19 articles, 2 were excluded due to the insufficient reported data for the estimation of HR, 3 were excluded because they put R1 resection and R2 resection together, and 2 were excluded due to the small sample size (there are only 2 cases with R1 margin in both studies)1718. Finally, a total of 12 studies141516192021222324252627 were included in this meta-analysis. Literatures screening process was shown in Fig. 1.

Bottom Line: Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128-2.258; I(2) = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608-3.363; I(2) = 60.8%, P value = 0.013).The level of evidence achieved in this study was "moderate" for DFS and "low" for OS.In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, the Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, China.

ABSTRACT
The impact and management of microscopically positive margins in gastrointestinal stromal tumors (GISTs) remain unclear. The aim of this study is to estimate the prognostic value of surgical margins for disease-free survival (DFS) and overall survival (OS) in patients with primary GISTs. Twelve studies with 1985 GIST patients were included. The overall recurrence rate in R1 resection and R0 resection group was 0.364 (95% CI 0.299-0.429) and 0.296 (95% CI 0.161-0.430), respectively. Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128-2.258; I(2) = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608-3.363; I(2) = 60.8%, P value = 0.013). Importantly, subgroup analysis revealed that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. (HR 1.308, 95% CI 0.583-2.935; I(2) = 53.2%, P value = 0.074). The level of evidence achieved in this study was "moderate" for DFS and "low" for OS. In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.

No MeSH data available.


Related in: MedlinePlus