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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

Meta-analysis and stratified analysis of hazard ratios of R1 resection for disease-free survival.Each study is shown by the name of the first author and the hazard ratio (HR) with 95% confidence intervals (CIs).
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f3: Meta-analysis and stratified analysis of hazard ratios of R1 resection for disease-free survival.Each study is shown by the name of the first author and the hazard ratio (HR) with 95% confidence intervals (CIs).

Mentions: Meta-analysis using a random-effects model indicated that R1 resection had an unfavorable DFS compared with R0 resection (HR 1.596, 95% CI 1.128–2.258; I2 = 37.5%, P value = 0.091), which was consistent with the results of the fixed-effects model (HR 1.567, 95% CI 1.246–1.969) (Fig. 3). To determine whether other factors had an influence on the HR of DFS, we carried out subgroup analysis and meta-regression analysis. Table 3 demonstrates the overall and stratified analysis. Notably, in the adjuvant imatinib treatment subgroup, the patients with R1 resection showed no significant difference of DFS compared with R0 resection (HR 1.308, 95% CI 0.583–2.935; I2 = 53.2%, P value = 0.074). In the subgroup without adjuvant imatinib treatment, DFS of R1 resection still remained poor (HR 1.758, 95% CI 1.338–2.310; I2 = 11.3%, P value = 0.343). These results indicate that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. Sensitivity analysis indicated that pooled HR was not significantly influenced by omission of any single study.


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)

Meta-analysis and stratified analysis of hazard ratios of R1 resection for disease-free survival.Each study is shown by the name of the first author and the hazard ratio (HR) with 95% confidence intervals (CIs).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: Meta-analysis and stratified analysis of hazard ratios of R1 resection for disease-free survival.Each study is shown by the name of the first author and the hazard ratio (HR) with 95% confidence intervals (CIs).
Mentions: Meta-analysis using a random-effects model indicated that R1 resection had an unfavorable DFS compared with R0 resection (HR 1.596, 95% CI 1.128–2.258; I2 = 37.5%, P value = 0.091), which was consistent with the results of the fixed-effects model (HR 1.567, 95% CI 1.246–1.969) (Fig. 3). To determine whether other factors had an influence on the HR of DFS, we carried out subgroup analysis and meta-regression analysis. Table 3 demonstrates the overall and stratified analysis. Notably, in the adjuvant imatinib treatment subgroup, the patients with R1 resection showed no significant difference of DFS compared with R0 resection (HR 1.308, 95% CI 0.583–2.935; I2 = 53.2%, P value = 0.074). In the subgroup without adjuvant imatinib treatment, DFS of R1 resection still remained poor (HR 1.758, 95% CI 1.338–2.310; I2 = 11.3%, P value = 0.343). These results indicate that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. Sensitivity analysis indicated that pooled HR was not significantly influenced by omission of any single study.

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