Advanced gastrointestinal stromal tumor patients benefit from palliative surgery after tyrosine kinase inhibitors therapy.
Advanced gastrointestinal stromal tumor patients benefit from palliative surgery after tyrosine kinase inhibitors therapy.
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晚期胃肠道间质瘤患者在酪氨酸激酶抑制剂治疗后受益于姑息手术
DOI：
10.1097/md.0000000000009097
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发表时间：
2018-01
期刊：
影响因子：
1.6
通讯作者：
Zhou ZW
中科院分区：
文献类型：
--
作者：
Qiu HB;Zhou ZG;Feng XY;Liu XC;Guo J;Ma MZ;Chen YB;Sun XW;Zhou ZW
摘要晚期胃肠道间质瘤(GIST)经酪氨酸激酶抑制剂(TKIs)治疗后，姑息性手术的作用存在争议。我们评估了2002年1月至2008年12月期间单一机构的一系列晚期GIST患者的安全性和临床结果。共纳入156例患者，其中87例接受手术切除，69例继续接受TKIs治疗。有4名患者出现了严重的手术并发症。中位随访期为38.3月，手术组总生存期(OS)和无进展生存期(PFS)分别为46.1月和33.8月(P <； .01)，OS分别为54.8月和40.4月。在对接受手术的患者进行的亚组分析中，进展期、稳定期和部分缓解期的中位PFS分别为33.3月、51.5月和83.0月(P <； .01)。仅有肝或腹膜转移者的中位OS为68.0个月，两者均有转移者的中位OS为45.3个月。行R0/R1根治术的患者中位无瘤生存时间为73.6个月，行R2根治术的患者中位无瘤生存时间为35.8个月(P <； .01)。晚期GIST患者术后OS延长。对于TKIS治疗后有反应性疾病的患者，应考虑手术治疗。
Abstract The role of palliative surgery is controversial in advanced gastrointestinal stromal tumors (GIST) after tyrosine kinase inhibitors (TKIs) therapy. We evaluated safety and clinical outcomes in a single institution series of advanced GIST patients from January 2002 to December 2008. One hundred and fifty-six patients had been recruited, including 87 patients underwent surgical resection and 69 patients kept on TKIs treatment. Four patients had major surgical complications. Median follow-up was 38.3 months, the overall survival (OS) and progression-free survival (PFS) of the patients in surgical group were longer than the nonsurgical group, PFS: 46.1 versus 33.8 months (P < .01), OS: 54.8 versus 40.4 months. In the subgroup analysis for the patients received surgery, the median PFS for patients with progression disease, stable disease, and partial response was 33.3, 51.5, and 83.0 months, respectively (P < .01). Median OS was 68.0 months in those with only liver or peritoneal metastases, and 45.3 months in those with both metastases. Median PFS of patients underwent R0/R1 resection was 73.6 months compared with 35.8 months in R2 resection patients (P < .01). Patients with advanced GISTs have prolonged OS after debulking procedures. Surgery for patients who have responsive disease after TKIs treatment should be considered.