靶向药物时代背景下进展期胃肠间质瘤手术治疗相关的若干问题之再思考  

Rethinking several issues related to surgical treatment for advanced GIST in the era of targeted therapy

作　　者：汪明[1] 曹晖[1] Wang Ming;Cao Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中华胃肠外科杂志》2024年第11期1107-1116,共10页Chinese Journal of Gastrointestinal Surgery

摘　　要：胃肠间质瘤(GIST)是胃肠道最常见的间叶源性肿瘤,酪氨酸激酶抑制剂(TKI)对GIST的治疗取得了巨大的成功,外科手术在进展期GIST中的作用和价值尚存在争议。本文梳理靶向药物治疗时代背景下进展期GIST手术相关的研究进展,尤其探讨手术与靶向药物相结合的相关问题。研究显示,有选择性地筛选部分进展期GIST可以从外科手术中获益,但尚缺乏可普遍接受的筛选标准和操作规范,手术时机、肿瘤本身的生物学特性、以及外科医师对手术及围手术期的细节管理等多种因素均影响到进展期GIST手术治疗的效果。应针对伊马替尼耐药GIST或是后线TKI耐药GIST患者制定不同的手术策略。在伊马替尼应答期间选择减瘤手术,最有可能改善患者的生存,应发现和抓住早期或局限性进展者予以及时的手术干预。舒尼替尼或瑞戈非尼联合手术的研究目前较少,其可行性和价值仍存在争议。瑞派替尼联合减瘤手术可能是新的突破点。Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors in the gastrointestinal tract,and tyrosine kinase inhibitors(TKIs)have achieved great success in the treatment of GISTs.The role and value of surgery in advanced GISTs are still controversial.This article aims to review the progress related to surgery for advanced GIST in the context of targeted therapy,particularly exploring the issues related to the combination of surgery and targeted therapy.Studies have shown that selected advanced GISTs can benefit from surgery,but there is still a lack of universally accepted screening criteria and operational norms,and multiple factors affect the effectiveness of surgical treatment for advanced GISTs.Different surgical strategies should be developed for imatinib-resistant GISTs or multiple TKI-resistant GISTs.During the period when the tumors respond to imatinib,cytoreductive surgery is most likely to improve the survival of patients.Early or localized progression should be identified and promptly intervened with surgery.At present,there are few studies on sunitinib or regorafenib combined with surgery,and their feasibility and value are still controversial.Ripretinib combined with cytoreductive surgery may be a new breakthrough point.

关 键 词：胃肠间质瘤 靶向药物 外科治疗 伊马替尼 

分 类 号：R735[医药卫生—肿瘤]