Thermal ablation versus hepatic resection for the treatment of liver metastases from gastrointestinal stromal tumors: a retrospective study

Figures & data

Table 1. Patient and tumor characteristics.

Characteristics	Ablation (n = 27)	Surgery (n = 28)	All (n = 55)	p Value
Age >60 years	13 (48.1%)	10 (35.7%)	23 (41.8%)	.350
Sex
Male	21 (77.8%)	18 (64.3%)	39 (70.9%)	.271
Female	6 (22.2%)	10 (35.7%)	16 (29.1%)
HBsAg (+)	1 (3.7%)	2 (7.1%)	3 (5.4%)	.597
Child–Pugh A	24 (88.9%)	27 (96.4%)	51 (92.7%)	.352
CA125 <35 U/ml	23 (85.2%)	24 (85.7%)	47 (85.4%)	1.000
CEA <5 ng/ml	27 (100%)	28 (100%)	55 (100%)	–
Primary tumor site				.527
Stomach	10 (37.0%)	8 (28.6%)	18 (32.7%)
Small bowel	16 (59.3%)	17 (60.7%)	33 (60.0%)
Other	1 (3.7%)	3 (10.7%)	4 (7.3%)
Liver metastases in relation to the primary tumor				.343
Synchronous	11 (40.7%)	8 (28.6%)	19 (34.5%)
Metachronous	16 (59.3%)	20 (71.4%)	36 (65.5%)
Median interval time	46 (21–96)	37 (10.5–70.2)	36 (25.7–75.5)
Extrahepatic metastases	5 (18.5%)	13 (46.4%)	18 (32.7%)	.394
Gastrointestinal tract	0	1 (3.6%)	1 (1.8%)
Peritoneal implantation	5 (18.5%)	11 (39.3%)	16 (29.1%)
Other	0	1 (3.6%)	1 (1.8%)
Tumor number^a	1.0 (1.0–3.0)	1.0 (1.0–3.0)	1.0 (1.0–3.0)	.122
Size of largest metastasis (cm)	2.3 (1.6–3.9)	5.0 (1.9–12)	2.8 (1.8–7.7)	.065
Preoperative TKI treatment (yes)	18 (66.7%)	20 (71.4%)	38 (69.1%)	.702
Preoperative TKI treatment (PD)	16 (59.2%)	13 (46.4%)	29 (52.7%)	.341
Postoperative TKI treatment (yes)	26 (96.3%)	25 (89.3%)	51 (92.7%)	.611
Length of hospital stay (days)	8 (5–15)	16.5 (14–22.2)	14 (8–18)	.001
Complications				.001
None	22 (81.5%)	6 (21.4%)	28 (50.9%)
Minor	5 (18.5%)	19 (67.9%)	24 (43.6%)
Major	0	3 (10.7%)	3 (5.5%)

PD: progressive disease.

^a Median (interquartile range).

Table 2. Details of ablation and surgery.

	Number
Ablation
Type of ablation
RFA	20 (74.1%)
RFA + PEI	2 (7.4%)
MWA	3 (11.1%)
MWA + PEI	2 (7.4%)
Ablation session no.
1	53 (98.1%)
2	0
3	1 (1.9%)
Technical success	27 (100%)
Follow-up treatment
TKI treatment only	14 (51.9%)
TKI treatment + ablation	5 (18.5%)
TKI treatment + ablation + TACE	2 (7.4%)
TKI treatment + surgery	4 (14.8%)
TKI treatment + surgery + TACE	1 (3.7%)
None	1 (3.7%)
Surgery
Type of surgery
Hemihepatectomy	6 (21.4%)
Sectionectomy	13 (46.4%)
Segmentectomy or bisegmentectomy	9 (32.1%)
Removal of primary GISTs simultaneously	7 (25.0%)
Outcome of surgery
R0 resection	24 (85.7%)
R1/R2 resection	4 (14.3%)
Follow-up treatment
TKI treatment only	17 (60.7%)
TKI treatment + ablation	8 (28.6%)
TKI treatment + surgery	0
None	2 (7.1%)
Other	1 (3.6%)

RFA: radiofrequency ablation; MWA: microwave ablation; PEI: percutaneous ethanol ablation; TKI: tyrosine kinase inhibitor; TACE: transcatheter hepatic arterial chemoembolization.

Table 3. Patient outcomes following thermal ablation and surgery.

	Ablation group (n = 27)	Surgery group (n = 28)
Median follow-up time (months)	63.0 (44.1–81.9)	42.0 (13.0–71.0)
Death	9 (33.3%)	7 (25%)
Progression	22 (81.5%)	9 (32.1%)
Progression-free survival
Median (months)	12.0	NR
1-year	48.1%	67.8%
3-year	25.9%	64.3%
5-year	18.5%	64.3%
Postoperative progression site	22 (81.5%)	9 (32.1%)
Intrahepatic	8 (29.6%)	3 (10.7%)
Extrahepatic	2 (7.4%)	3 (10.7%)
Intrahepatic and extrahepatic	12 (44.4%)	3 (10.7%)
Overall survival
Median (months)	102.0	117.0
1-year	100%	92.8%
3-year	88.9%	82.1%
5-year	74.1%	78.6%

Figure 1. Curves of progression-free survival (PFS).

Table 4. Univariate and multivariate analyses using Cox proportional hazards regression modeling.

	Progression-free survival				Overall survival
	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
	HR (95% CI)	p Value	HR (95% CI)	p Value	HR (95% CI)	p Value	HR (95% CI)	p Value
Age >60 years	2.548 (1.268–5.120)	.009	1.890 (0.902–3.959)	.092	1.996 (0.721–5.525)	.183
Sex (male)	0.832 (0.395–1.753)	.629			0.785 (0.245–2.515	.684
Treatment group (surgery)	0.362 (0.172–0.762)	.007	0.448 (0.197–1.020)	.056	1.083 (0.399–2.942)	.875
Synchronous liver metastases	1.038 (0.501–2.154)	.919			2.293 (0.650–8.090)	.197
Extrahepatic metastases	0.820 (0.407–1.651)	.579			0.484 (0.155–1.515)	.213
Primary GIST location in stomach	1.000 (0.484–2.065)	1.000			0.548 (0.198–1.514)	.246
HBsAg (+)	0.614 (0.083–4.523)	.632			0.044 (0–638.0)	.523
Child–Pugh B	1.991 (0.692–5.734)	.202			2.036 (0.452–9.166)	.354
CA125 ≥hx2009;35 U/ml	1.030 (0.423–2.506)	.949			2.168 (0.675–6.959)	.193
Preoperative TKI treatment (yes)	2.438 (1.117–5.320)	.025	3.358 (0.947–11.907)	.061	3.646 (0.824–16.123)	.088
Preoperative TKI treatment (PD)	3.353 (1.562–7.198)	.002	0.965 (0.332–2.804)	.947	16.147 (2.103–123.964)	.007	13.985 (1.791–109.187)	.012
Tumor number	1.628 (1.280–2.071)	.001	1.318 (1.021–1.702)	.034	1.508 (1.073–2.118)	.018	1.328 (0.926–1.904)	.123
Size of largest metastasis (cm)	0.968 (0.903–1.037)	.355			1.028 (0.946–1.118)	.513

GIST: gastrointestinal stromal tumor; PD: progressive disease.

Figure 2. Curves of overall survival (OS).