Cao Hui, Wang Ming
Department of Gastrointestinal Surgery, The Affiliated Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Nov 25;19(11):1211-1216.
Gastrointestinal stromal tumor(GIST) is the most common mesenchymal tumor in the gastrointestinal tract. Due to the occult onset, GIST may present as local advanced or with metastatic disease at diagnosis. Imatinib mesylate (IM) has effectively improved the prognosis of GIST patients and has been established as principle therapy in metastatic GIST. The role of IM as an adjunction to surgery in the management of high-risk and local advanced GIST is also highly regarded. The role of surgery in metastatic or recurrent GIST is still a controversial clinic problem. For local advanced GIST or GIST in the unfavorable anatomic site(e.g. esophagogastric junction, duodenum, and rectum), based on the limited evidence, surgery may have potential benefits as conversion therapy. Surgery may have a limited favorable impact on progression-free survival and overall survival for those patients whose disease is responding to imatinib or those with limited focal progression. Patients with extensive advanced relapse metastatic GIST or imatinib-resistant disease should not undergo surgery unless emergency situation or complication occurs, where palliative intervention may be justified.
胃肠道间质瘤（GIST）是胃肠道最常见的间叶组织肿瘤。由于起病隐匿，GIST在诊断时可能表现为局部进展期或伴有转移性疾病。甲磺酸伊马替尼（IM）有效改善了GIST患者的预后，并已成为转移性GIST的主要治疗方法。IM作为高危和局部进展期GIST手术辅助治疗的作用也备受重视。手术在转移性或复发性GIST中的作用仍是一个有争议的临床问题。对于局部进展期GIST或位于解剖学上不利部位（如食管胃交界、十二指肠和直肠）的GIST，基于有限的证据，手术作为转化治疗可能具有潜在益处。对于疾病对伊马替尼有反应或仅有局限性病灶进展的患者，手术对无进展生存期和总生存期的有利影响可能有限。广泛的晚期复发转移性GIST或伊马替尼耐药疾病的患者，除非出现紧急情况或并发症，否则不应接受手术，此时姑息性干预可能是合理的。
