Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Surg Res. 2012 Oct;177(2):248-54. doi: 10.1016/j.jss.2012.07.005. Epub 2012 Jul 20.
Operative resection of metastatic gastrointestinal stromal tumors (GIST) is controversial. Current treatment strategies rely on the response to tyrosine kinase inhibitors (TKIs), with resultant individualization of operative intervention. We investigated the role of operative therapy in patients with metastatic GIST.
This retrospective cohort study included all consecutive patients treated for metastatic and/or recurrent GIST from January 2002 to June 2011. The patients were stratified by the use of operative therapy and disease response to TKI therapy. Kaplan-Meier survival analyses with log-rank comparisons tested the effects of operative therapy and the response to TKIs on survival.
Of the 438 patients treated for GIST during the study period, 87 (median age 61 y, interquartile range 50-71; 55% male) had metastatic GIST (84% metastatic, 3% recurrent, and 13% metastatic and recurrent). Of these patients, 54 (62%) underwent operative exploration. Subtotal resection for palliative debulking (R2 resection) were performed in 19 patients; 32 patients underwent R0 resection. Operative intervention was associated with improved overall survival (OS) compared with systemic therapy alone (1 y OS, 98% versus 80% and 5-y OS, 65% versus 11%, respectively; P < 0.001). A TKI was used before resection in 32 patients. The disease response was partial in 13 patients, stable in 10, and progressive in 9. The 1- and 5-y OS and progression-free survival were strongly associated with the preoperative response to TKI and an R0 resection (all P ≤ 0.002).
Among patients with metastatic GIST, preoperative response to TKI therapy and margin-negative resection were strongly associated with improved progression-free and OS.
胃肠道间质瘤（GIST）的转移性肿瘤的手术切除存在争议。目前的治疗策略依赖于酪氨酸激酶抑制剂（TKI）的反应，从而实现手术干预的个体化。我们研究了手术治疗在转移性 GIST 患者中的作用。
本回顾性队列研究纳入了 2002 年 1 月至 2011 年 6 月期间所有接受转移性和/或复发性 GIST 治疗的连续患者。患者根据手术治疗和 TKI 治疗的疾病反应进行分层。采用 Kaplan-Meier 生存分析和对数秩检验检测手术治疗和 TKI 反应对生存的影响。
在研究期间，438 例 GIST 患者中 87 例（中位年龄 61 岁，四分位距 50-71；55%为男性）患有转移性 GIST（84%转移性，3%复发性，13%转移性和复发性）。这些患者中，54 例（62%）进行了手术探查。19 例患者行姑息性减瘤术（R2 切除术）；32 例患者行 R0 切除术。与单纯全身治疗相比，手术干预与改善总生存（OS）相关（1 年 OS，98%比 80%；5 年 OS，65%比 11%；P<0.001）。32 例患者在切除前使用了 TKI。疾病反应在 13 例患者中为部分缓解，在 10 例患者中为稳定，在 9 例患者中为进展。1 年和 5 年的 OS 和无进展生存率与术前对 TKI 的反应和 R0 切除术密切相关（均 P≤0.002）。
在转移性 GIST 患者中，术前对 TKI 治疗的反应和阴性切缘的切除与无进展生存和 OS 的改善密切相关。
