부산대학교 도서관

Byline: M. Fairweather, M. J. Cavnar, G. Z. Li, M. M. Bertagnolli, R. P. DeMatteo, C. P. Raut Background Although cytoreductive surgery has been shown to be beneficial in carefully selected patients with metastatic gastrointestinal stromal tumours (GISTs) treated with tyrosine kinase inhibitors (TKIs), factors predictive of postoperative morbidity have not been investigated previously. Methods A surgical complexity score for GIST metastasectomy (GM-SCS) composed of patient-related and surgical factors was assigned retrospectively to patients with metastatic GIST treated with TKI therapy and surgery at two institutions between 2002 and 2014. The ability of clinicopathological factors and GM-SCS to predict postoperative morbidity was assessed by means of a multivariable logistic regression model. Postoperative complications were categorized using the Clavien-Dindo classification. Results Some 400 operations on 323 patients with metastatic GIST on TKIs were included. Complications were observed following 110 operations (27ae5 per cent) including 70 major complications (grade III-V) (17ae5 per cent of 400 operations). Patients were divided into low (5 points or less; 100 patients, 25ae0 per cent), intermediate (6-9 points; 191, 47ae8 per cent) and high (at least 10 points; 109, 27ae3 per cent) complexity scoring groups based on the GM-SCS. An intermediate (odds ratio (OR) 2ae88; P = 0ae008) and high (OR 5ae40; P < 0ae001) GM-SCS were independent predictors of overall complications, whereas only a high GM-SCS was independently predictive of a major complication (OR 3ae65; P = 0ae018). Metastatic mitotic index was also an independent predictor of overall complications (OR 2ae55; P = 0ae047). GM-SCS did not predict progression-free or overall survival. Conclusion A gastrointestinal stromal tumour metastastectomy surgical complexity score can predict morbidity, which may help in preoperative risk stratification and optimal treatment planning. CAPTION(S): Appendix S1 Examples of calculation of GM-SCS for individual patients Fig. S1 Distribution of frequency of patients by individual GIST Metastasectomy Surgical Complexity Score Fig. S2 Distribution of independent predictors of worse progression-free survival and overall survival by GIST Metastasectomy Surgical Complexity Score groups Table S1 Clinicopathologic characteristics for 323 patients with metastatic GIST treated with TKI followed by metastasectomy (400 operations)[] Table S2 Univariable analysis of treatment and tumour variables on complication rates for patients with metastatic GIST treated with TKI therapy and surgery (400 operations)