Genomic Complexity as a Biomarker to De-Escalate Adjuvant Imatinib Treatment in High-Risk Gastrointestinal Stromal Tumor

Author:

Boye Kjetil1ORCID,Gorunova Ludmila2,Gunawan Bastian3,Hompland Ivar1,Sander Bjoern34ORCID,Panagopoulos Ioannis2,Langer Claus5,Golas Monika67ORCID,Heim Sverre28,Füzesi László39,Hølmebakk Toto10,Micci Francesca2ORCID

Affiliation:

1. Department of Oncology, Oslo University Hospital, Oslo, Norway

2. Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway

3. Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany

4. Institute of Pathology, Hannover Medical School, Hannover, Germany

5. Clinic for General, Visceral, Thoracic and Minimally Invasive Surgery, Evangelical Hospital Göttingen-Weende, Göttingen, Germany

6. Human Genetics, Faculty of Medicine, University of Augsburg, Augsburg, Germany

7. Comprehensive Cancer Center Augsburg, University Medical Center Augsburg, Augsburg, Germany

8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

9. Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany

10. Department of Abdominal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway

Abstract

PURPOSE Adjuvant imatinib treatment is recommended for patients with localized gastrointestinal stromal tumor (GIST) at high risk of recurrence. Almost half of high-risk patients are cured by surgery alone, indicating a need for improved selection of patients for adjuvant therapy. The aim of this study was to investigate if genomic tumor complexity could be used as a prognostic biomarker. METHODS The discovery cohort consisted of patients who underwent resection of primary GIST at Oslo University Hospital between 1998 and 2020. Karyotypes were categorized as simple if they had ≤ 5 chromosomal changes and complex if there were > 5 chromosomal aberrations. Validation was performed in an independent patient cohort where chromosomal imbalances were mapped using comparative genomic hybridization. RESULTS Chromosomal aberrations were detected in 206 tumors, of which 76 had a complex karyotype. The most frequently observed changes were losses at 14q, 22q, 1p, and 15q. The 5-year recurrence-free survival (RFS) in patients classified as very low, low, or intermediate risk was 99%. High-risk patients with a simple tumor karyotype had an estimated 5-year RFS of 94%, and patients with a complex karyotype had an estimated 5-year RFS of 51%. A complex karyotype was associated with poor RFS in patients with and without adjuvant imatinib treatment and in multivariable analysis adjusted for tumor site, size, mitotic count, and rupture. The prognostic impact of genomic complexity was confirmed in the validation cohort. In both cohorts, the 5-year disease-specific survival was > 90% for high-risk patients with genomically simple tumors. CONCLUSION Genomic tumor complexity is an independent prognostic biomarker in localized, high-risk GIST. Recurrences were infrequent for tumors with simple karyotypes. De-escalation of adjuvant imatinib treatment should be explored in patients with cytogenetically simple GISTs.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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