Andtbacka Robert H I, Ng Chaan S, Scaife Courtney L, Cormier Janice N, Hunt Kelly K, Pisters Peter W T, Pollock Raphael E, Benjamin Robert S, Burgess Michael A, Chen Lei L, Trent Jonathan, Patel Shreyaskumar R, Raymond Kevin, Feig Barry W
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Ann Surg Oncol. 2007 Jan;14(1):14-24. doi: 10.1245/s10434-006-9034-8.
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.
Patients were retrospectively assessed for completeness of surgical resection and for disease-free and overall survival after resection.
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.
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.
手术切除胃肠道间质瘤（GIST）一直是治疗这些罕见肿瘤最有效的方法。伊马替尼已被引入作为局部晚期和转移性GIST的全身治疗药物。在本研究中，评估了术前使用伊马替尼治疗局部晚期原发性、复发性或转移性GIST患者的手术切除率和长期预后。
对患者进行回顾性评估，以确定手术切除的完整性以及切除后的无病生存期和总生存期。
46例患者在接受伊马替尼治疗后接受了手术。11例患者接受局部晚期原发性GIST治疗，中位治疗时间为11.9个月，随后进行了完整的手术切除。所有11例患者在中位时间19.5个月时均存活，10例无疾病。35例患者接受复发性或转移性GIST治疗。其中，11例接受了完整切除。11例患者中有6例在中位时间15.1个月时出现复发性疾病。所有11例患者在中位时间30.7个月时均存活。伊马替尼治疗后影像学肿瘤部分缓解的患者的完整切除率显著高于疾病进展的患者（91%对4%；P<0.001）。在24例未完全切除的患者中，18例最初对伊马替尼有反应，但在手术前病情进展后无法进行完整切除。
术前伊马替尼可减小肿瘤体积，并与局部晚期原发性GIST的完整手术切除相关。对于伊马替尼敏感的复发性或转移性GIST，应考虑早期手术干预，因为一旦肿瘤进展，很少能实现完整切除。
