舒尼替尼治疗伊马替尼耐药进展的胃肠间质瘤28例疗效分析  

Efficacy of sunitinib on gastrointestinal stromal tumor patients with imatinib resistance

作　　者：蔡明志[1] 张李[1] 邓靖宇[1] 王晓娜[1] 王宝贵[1] 刘宁[1] 潘源[1] 张汝鹏[1] 崔青皓[1] 梁寒[1] 

机构地区：[1]天津医科大学肿瘤医院胃肠肿瘤科,天津市肿瘤防治重点实验室,国家肿瘤临床医学研究中心,300060

出　　处：《腹部外科》2013年第6期384-388,共5页Journal of Abdominal Surgery

基　　金：国家重点研究发展计划973计划（2010CB529301）;天津市科技计划项目（12ZCDZSY16400）

摘　　要：目的 探讨舒尼替尼治疗伊马替尼耐药进展的胃肠间质瘤的疗效及预后影响因素.方法 回顾性分析自2008年11月至2013年2月间接受舒尼替尼治疗的28例伊马替尼耐药的胃肠间质瘤患者的临床病理资料,评价舒尼替尼疗效及不良反应,比较原发灶不同基因突变类型、有无再行减瘤手术等因素对患者预后的影响.结果 总体中位无进展生存时间7个月（3~28个月）,总体中位生存时间为13个月（3~48个月）.野生型、外显子9突变以及外显子11突变患者中位PFS分别为7个月、10个月和6个月,中位总生存期（OS）分别为22个月、13个月和9个月,且前两者预后优于后者.多因素预后分析显示,原发灶基因突变类型以及联合手术治疗是影响患者预后的独立因素.结论 舒尼替尼治疗伊马替尼耐药进展的GIST是安全有效的.原发病灶基因突变类型可以作为舒尼替尼二线治疗的独立预后因素.此外,同时联合外科干预可以改善伊马替尼耐药且局部进展的GIST患者预后,但需严格掌握手术适应证.Objective To investigate the efficacy of sunitinib on gastrointestinal stromal tumor （GIST） patients with imatinib resistance. Methods Clinical data of 28 patients with imatinib-resistant GIST undertaking sunitinib therapy from November 2008 to February 2013 in department of gastroin- testinal cancer of Tianjin medical university were analyzed retrospectively. Results Overall mPFS and mOS were 7 months and 13 months respectively. Median PFS of patients with wild type, exon 9 muta- tion and exon t 1 mutations were 7 months, 10 months and 6 months respectively. The mOS were 22months, 13months and 9months respectively. The PFS and OS of patients with wild type and exon 9 mutation were significantly longer than patients with exon l 1 mutation. The results of multivariate analysis showed that the mutational status of c-kit of primary lesion and combined surgery were the in- dependent factors influencing the PFS and OS. Conclusion Sunitinib is effectively used to treat pa- tients with imatinib-resistant advanced GIST. A better survival rate can be observed in patients with exon 9 mutation or with no gene mutation when compared with patients with exon 1 ~ mutation. Pa- tients can benefit from surgery when they are treated with sunitinib.

关 键 词：胃肠间质瘤 舒尼替尼 伊马替尼 治疗 预后 

分 类 号：R697.32[医药卫生—泌尿科学]