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机构地区:[1]中山大学肿瘤防治中心胃外科华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广州510060
出 处:《中华胃肠外科杂志》2017年第9期961-965,共5页Chinese Journal of Gastrointestinal Surgery
基 金:国家自然科学基金(81372474,81602061);广州市科技计划(2014J4100179)
摘 要:手术是局限型无转移胃肠间质瘤(GIST)的首选治疗方法.然而.即使肿瘤完整切除后仍有一部分患者出现肿瘤复发和转移。伊马替尼用于中高危患者的辅助治疗,可明显提高患者的无复发生存时间.但是否能够延长患者的总体生存时间目前尚无定论。对于中高危GIST患者予以辅助治疗目前已经有了共识,但辅助治疗时限目前仍然还在摸索,特别是针对高危患者,推荐辅助治疗至少3年,但在结束治疗后仍有部分患者复发转移。最新的PERSIST-5研究结果显示,5年辅助治疗或能进一步延长无复发生存时间。此外,辅助治疗尚未完全结合不同的基因类型进行个体化指导,目前的治疗推荐仍然仅针对CDll7阳性表达、且具有中高危复发风险的GIST患者。期待未来更多研究结果的公布能为临床治疗提供更好的指导。Surgery remains the primary treatment for patients with localized gastrointestinal stromal tumor (GIST), however, even after complete resection of the tumor, there is still a part of patients with tumor recurrence and metastasis.Imatinib, as adjuvant therapy in GIST patients with intermediate and high risk of recurrence, can significantly improve the disease-free survival, but whether it can prolong the overall survival is still unknown. It has reached a consensus that the intermediate and high risk patients should receive adjuvant therapy, but the duration for adjuvant therapy is still under investigation, especially for high-risk patients. Adjuvant therapy is recommended for at least 3 years, while in the end of adjuvant therapy, some patients still develop recurrence and metastasis. In 2017, results from PERSIST-5 study reported by the ASCO conference indicated that 5-year adjuvant therapy may further prolong disease-free survival of intermediate and high risk patients. In addition, adjuvant therapy is still not individualized based on the combination with different genotypes, and present adjuvant therapy is recommended for GIST patients with positive CDll7 and intermediate-high risk of recurrence. It remains controversial whether different genotypes are associated with alternative adjuvant treatment options. Results of more researches are expected to provide better guidance for clinical treatment in the future.
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