Surgical resection of gastrointestinal stromal tumors after treatment with imatinib
Surgical resection of gastrointestinal stromal tumors after treatment with imatinib
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DOI：
10.1245/s10434-006-9034-8
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发表时间：
2007-01-01
影响因子：
3.7
通讯作者：
Feig, Barry W.
中科院分区：
文献类型：
--
作者：
Andtbacka, Robert H. I.;Ng, Chaan S.;Feig, Barry W.
背景：手术切除胃肠道间质瘤(GIST)是治疗这些罕见肿瘤最有效的方法。伊马替尼已被引入为局部晚期和转移性胃肠道间质瘤的全身治疗方法。在这项研究中，本研究评估了接受伊马替尼治疗的局部晚期原发、复发或转移性胃肠道间质瘤患者的手术切除率和远期疗效。方法：回顾分析手术切除的完成性、术后无瘤生存率和总生存率。结果：46例患者在接受伊马替尼治疗后接受了手术治疗。11例接受局部晚期原发GIST的治疗，平均治疗时间为11.9个月，随后完全手术切除。所有11名患者的中位生存期为19.5个月，其中10名患者没有患病。35例患者接受了复发或转移性胃肠间质瘤的治疗。其中，11例完全切除。11名患者中有6名复发，中位数为15.1个月。11例患者均存活，中位生存期为30.7个月。对伊马替尼有部分放射学反应的患者的完全切除率显著高于进展性疾病患者(91%比4%；P<；.001)。在24例不完全切除的患者中，18例最初对伊马替尼有反应，但在手术前进展后无法完全切除。结论：在局部晚期原发GIST中，伊马替尼可以减少肿瘤体积，并与完全手术切除有关。对于对伊马替尼敏感的复发或转移性胃肠道间质瘤，应考虑早期手术治疗，因为一旦肿瘤进展，完全切除的可能性很小。
Background: Surgical resection of gastrointestinal stromal tumors (GISTs) has been the most effective therapy for these rare tumors. Imatinib has been introduced as systemic therapy for locally advanced and metastatic GIST. In this study, the surgical resection rates and long-term outcomes of patients treated with preoperative imatinib for locally advanced primary, recurrent, or metastatic GISTs were evaluated.Methods: Patients were retrospectively assessed for completeness of surgical resection and for disease-free and overall survival after resection.Results: Forty-six patients underwent surgery after treatment with imatinib. Eleven were treated for locally advanced primary GISTs for a median of 11.9 months, followed by complete surgical resection. All eleven were alive at a median of 19.5 months, and ten were free of disease. Thirty-five patients were treated for recurrent or metastatic GIST. Of these, eleven underwent complete resection. Six of the eleven patients had recurrent disease at a median of 15.1 months. All eleven patients were alive at a median of 30.7 months. Patients with a partial radiographic tumor response to imatinib had significantly higher complete resection rates than patients with progressive disease (91% vs. 4%; P < .001). Of the 24 patients with incomplete resection, 18 initially responded to imatinib but were unable to undergo complete resection after they progressed before surgery.Conclusions: Preoperative imatinib can decrease tumor volume and is associated with complete surgical resection in locally advanced primary GISTs. Early surgical intervention should be considered for imatinib-responsive recurrent or metastatic GIST, since complete resection is rarely achieved once tumor progression occurs.