靶向药物治疗时代的柳叶刀——手术在晚期胃肠间质瘤治疗中的地位  

Lancet in the era of targeted drug therapy： the role of surgery in the management of advanced gastrointestinal stromal tumor

作　　者：曹晖[1] 汪明[1] 

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《中华胃肠外科杂志》2016年第11期1211-1216,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81272743）;上海科学技术委员会基金（13411950902）

摘　　要：胃肠间质瘤（GIST）是胃肠道最常见的间叶源性恶性肿瘤，由于起病隐匿。相当一部分病例在发现时已是局部晚期或已发生转移。分子靶向药物甲磺酸伊马替尼（IM）的问世，极大地改变了GIST的治疗模式。IM对于GIST的治疗最先应用于晚期GIST，且取得成功并迅速成为晚期GIST治疗“金标准”。在IM有效地延长了晚期GIST患者生存期的同时．手术在晚期GIST治疗中的地位成为了临床上越来越受关注的一个课题。目前，在高复发风险或局部晚期GIST的治疗中，IM已经通过手术后辅助治疗或术前新辅助治疗的形式与外科手术相结合。发挥了重要的作用。根据目前有限的循证医学证据，在局部晚期或“困难解剖部位（食管．胃结合部、十二指肠、直肠等）”的原发性GIST中，外科手术可以与IM结合，实现类似晚期胃癌治疗模式中的“转化治疗”；对于对IM治疗有一定反应（部分缓解、疾病稳定或局限性进展）的复发转移性GIST病例。外科手术可能为患者带来有限的生存获益：对于广泛进展的复发转移性GIST，外科手术指证应严格限制于出现并发症或急诊情况等综合情况的评判中。Gastrointestinal stromal tumor（GIST） is the most common mesenchymai tumor in the gastrointestinal tract. Due to the occult onset, GIST may present as local advanced or with metastatic disease at diagnosis. Imatinib mesylate （IM） has effectively improved the prognosis of GIST patients and has been established as principle therapy in metastatic GIST. The role of IM as an adjunction to surgery in the management of high-risk and local advanced GIST is also highly regarded. The role of surgery in metastatic or recuirent GIST is still a controversial clinic problem. For local advanced GIST or GIST in the unfavorable anatomic site（e.g, esophagogastric junction, duodenum, and rectum）, based on the limited evidence, surgery may have potential benefits as conversion therapy. Surgery may have a limited favorable impact on progressionfree survival and overall survival for those patients whose disease is responding to imatinib or those with limited focal progression. Patients with extensive advanced relapse metastatic GIST or imatinib-resistant disease should not undergo surgery unless emergency situation or complication occurs, where palliative intervention may be justified.

关 键 词：胃肠间质瘤 外科手术 靶向治疗 

分 类 号：R735[医药卫生—肿瘤]