Ye Ying-Jiang, Gao Zhi-Dong, Poston G J, Wang Shan
Department of Gastroenterology Surgery, Peking University People's Hospital, Beijing, China.
Eur J Surg Oncol. 2009 Aug;35(8):787-92. doi: 10.1016/j.ejso.2009.01.003. Epub 2009 Jan 29.
To explore the present application of diagnosis and management of hepatic metastases from GIST.
We performed a systematic review of the literature for studies concerning hepatic metastases from GIST. A literature search was performed using the Medline/PubMed databases to identify publications relevant to the review published from January 1998 to December 2008. Totally 113 relevant articles were retrieved. Abstracts from recent ASCO symposia were hand searched for relevant articles. After the primary filtration, articles on review and with repetitive content were excluded. The articles on clinical research, which were issued in authorized journals, were selected. At last, totally 69 articles were included for review.
The rate of liver metastases was reported as 15.9% in primary GISTs. The recurrence rate following surgical resection for hepatic metastases from GIST had been reported as 70-77%. For metastatic GIST patients with tyrosine kinase inhibitor (TKI) treatment, it demonstrated rates of CR, PR and SD respectively of 5.84%, 50.7%, and 32.4%. Combining repeated surgery with TKI treatment, R0/R1 resection rates range in various series between 48 and 82%. For those patients with unresectable disease confined to the liver or unable to tolerate liver resection due to co-morbidity or advanced age, RFA, HACE, TKI therapy, or even liver transplantation, can also improve survival.
The liver is a common metastatic site for gastrointestinal stromal tumour (GIST). Appropriate initial evaluation remains paramount for selecting the correct management strategy. Multi-disciplinary management (which includes pathology, medical oncology, surgical oncology, and imaging expertise) of this disease is important for both curative and palliative treatment in these patients. Combining repeated surgery with TKI treatment may be the most effective management for GIST patients with liver metastases.
探讨胃肠道间质瘤肝转移的诊断及治疗现状。
我们对有关胃肠道间质瘤肝转移的研究进行了系统的文献综述。利用Medline/PubMed数据库进行文献检索，以确定1998年1月至2008年12月发表的与本综述相关的出版物。共检索到113篇相关文章。人工检索近期美国临床肿瘤学会（ASCO）研讨会的摘要以查找相关文章。经过初步筛选，排除综述类文章及内容重复的文章。选取发表在权威期刊上的临床研究文章。最后，共纳入69篇文章进行综述。
原发性胃肠道间质瘤肝转移率报道为15.9%。胃肠道间质瘤肝转移手术切除后的复发率报道为70 - 77%。对于接受酪氨酸激酶抑制剂（TKI）治疗的转移性胃肠道间质瘤患者，完全缓解（CR）、部分缓解（PR）和疾病稳定（SD）率分别为5.84%、50.7%和32.4%。重复手术联合TKI治疗，不同系列的R0/R1切除率在48%至82%之间。对于那些不可切除但局限于肝脏或因合并症或高龄而无法耐受肝切除的患者，射频消融（RFA）、肝动脉化疗栓塞（HACE）、TKI治疗甚至肝移植，也可提高生存率。
肝脏是胃肠道间质瘤（GIST）常见的转移部位。恰当的初始评估对于选择正确的治疗策略至关重要。对该疾病进行多学科管理（包括病理学、医学肿瘤学、外科肿瘤学和影像学专业知识）对于这些患者的根治性和姑息性治疗都很重要。重复手术联合TKI治疗可能是胃肠道间质瘤肝转移患者最有效的治疗方法。
