Current clinical management of gastrointestinal stromal tumor.
Current clinical management of gastrointestinal stromal tumor.
复制标题
胃肠道间质瘤的当前临床治疗
DOI：
10.3748/wjg.v24.i26.2806
复制
发表时间：
2018-07-14
影响因子：
4.3
通讯作者：
Shiratsuchi Y
中科院分区：
文献类型：
--
作者：
Akahoshi K;Oya M;Koga T;Shiratsuchi Y
胃肠道间质瘤（GIST）是胃肠道最常见的恶性上皮下病变（SEL）。它们起源于位于肌肉层内的Cajal间质细胞，其特征在于酪氨酸激酶受体KIT的过度表达。在病理学上，GIST的诊断依赖于形态学和免疫组织化学[KIT和/或在胃肠道间质瘤1（DOG 1）上发现的通常为阳性]。其预后与肿瘤大小及核分裂指数有关。无转移的GIST的标准治疗是手术切除。伴有转移的GIST通常只能用酪氨酸激酶抑制剂治疗而不能根治，因此，早期诊断是改善其预后的唯一途径。然而，GIST通常在内窥镜检查期间被检测为SEL，并且许多良性和恶性状况可能表现为SEL。对于无溃疡的肿瘤，常规内镜活检是困难的。因此，大多数SEL在没有组织学诊断的情况下进行了管理。然而，GIST的良好预后与早期组织学诊断和R 0切除相关。超声内镜（EUS）和EUS引导下细针穿刺（EUS-FNA）对于准确诊断SEL至关重要。EUS-FNA是安全有效的，使早期组织学诊断和适当的治疗。本综述概述了目前的证据，诊断和管理的GIST，重点是早期管理的小SEL。
Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.
登录
查看更多内容
影响因子：
7.7
作者：
BOYCE, GA;SIVAK, MV;LEHMAN, GA
通讯作者：
LEHMAN, GA
影响因子：
7.7
作者：
Dolak, Werner;Beer, Andrea;Puespoek, Andreas
通讯作者：
Puespoek, Andreas
影响因子：
45.3
作者：
Blanke, Charles D.;Rankin, Cathryn;Borden, Ernest C.
通讯作者：
Borden, Ernest C.
影响因子：
7.7
作者：
Ando, N;Goto, H;Hayakawa, T
通讯作者：
Hayakawa, T
DOI：
10.1016/s0140-6736(12)61857-1
发表时间：
2013-01-26
期刊：
Lancet (London, England)
影响因子：
--
作者：
Demetri GD;Reichardt P;Kang YK;Blay JY;Rutkowski P;Gelderblom H;Hohenberger P;Leahy M;von Mehren M;Joensuu H;Badalamenti G;Blackstein M;Le Cesne A;Schöffski P;Maki RG;Bauer S;Nguyen BB;Xu J;Nishida T;Chung J;Kappeler C;Kuss I;Laurent D;Casali PG;GRID study investigators
通讯作者：
GRID study investigators