伊马替尼新辅助治疗联合手术对中晚期胃肠道间质瘤的疗效观察(附92例报告)  

Clinical efficacy of imatinib mesylate as neoadjuvant therapy combined with surgery in patients with advanced gastrointestinal stromal tumors(A report of 92 cases)

作　　者：曹志宇[1] 何建苗[1] 杨波[1] 张庆军[1] 翁剑锋[1] 史玉琪[1] 汪莉[1] 

机构地区：[1]解放军309医院普外科,北京100091

出　　处：《解放军医学杂志》2015年第5期408-410,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨伊马替尼及手术联合治疗中晚期胃肠道间质瘤的临床疗效。方法回顾性分析解放军309医院2007年1月-2012年1月收治的92例中晚期胃肠道间质瘤患者的临床资料。其中男57例,女35例,年龄21~85岁,病程1个月~2.5年。病变位于胃41例,空肠11例,回肠9例,结肠17例,直肠14例。伊马替尼新辅助治疗方案为400mg/d口服,连用3~9个月。按Choi疗效评价标准评价客观疗效并观察不良反应。结果 92例患者获随访,随访时间9~50个月,其中完全缓解（CR）2例,部分缓解（PR）45例,稳定（SD）31例,进展（PD）14例,死亡6例。临床有效率（CR＋PR）为51.1%（47/92）,疾病控制率（CR＋PR＋SD）为84.6%（78/92）。不良反应主要为不同程度的颜面部和下肢水肿、恶心呕吐等胃肠道反应以及白细胞减少等血液反应。新辅助治疗后54例患者进行了手术,手术切除率为58.7%（54/92）。92例患者的1年生存率为100%,3年生存率为93.4%。结论伊马替尼新辅助治疗对中晚期胃肠间质瘤的疗效较好,可延长患者生命,提高手术切除率,且不良反应较小,患者能长期耐受。Objective To evaluate the clinical efficacy of imatinib mesylate as an adjuvant therapy in combination with surger y for advanced gastrointestinal stromal tumors. Methods A total of 92 patients with advanced gastrointestinal stromal tumors, which were confirmed by pathological examination, were enrolled in this study from Jan. 2007 to Jan. 2012. There were 57 male and 35 female patients with age range of 21-85 years, and disease courses from one month to 2.5 years. The lesion was located in the stomach in 41 patients, jejunum in 11, ileum in 9, colon in 17, and rectum in 14. All of them received imatinib mesylate at a dose of 400mg/d for 3-9 months. According to Choi’s efficacy evaluation criteria, therapeutic efficacy and adverse reactions were recorded. Results All of the patients were followed up for 9-50 months. Two patients achieved complete response（CR）, 45 partial response（PR）, 31 stable disease（SD） and 14 had disease progression（PD）. Six patients died. The overall response rate（ORR） was 51.1% and disease control rate（DCR） was 84.6%. The adverse reactions were mainly facial and lower extremity edema to varying degrees, neutropenia, nausea and vomiting. Fifty-four patients received surgery after adjuvant therapy, the resection rate was 58.7%. The overall survival rates at 1 and 3 years were 100% and 93.4% respectively. Conclusions Imatinib mesylate as adjuvant therapy has good therapeutic efficacy for middle-late gastrointestinal stromal tumor. It can prolong patient life and improve the resection rate. Only mild adverse reactions occur and its toxicity is acceptable.

关 键 词：胃肠道间质肿瘤 放化疗 辅助 伊马替尼 

分 类 号：R730.53[医药卫生—肿瘤]