Shi Yi-Nan, Li Yong, Wang Li-Ping, Wang Zhen-Hua, Liang Xiao-Bo, Liang Han, Zhang Li, Li Bin, Fan Li-Qiao, Zhao Qun, Ma Zhi-Xue, Zhao Xue-Feng, Zhang Zhi-Dong, Liu Yu, Tan Bi-Bo, Wang Dong, Wang Li-Li, Hao Ying-Jie, Jia Nan
aDepartment of Minimally Invasive Gastrointestinal Surgery, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province bThe Third Department of Surgery, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province cSurgical Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
Medicine (Baltimore). 2017 Nov;96(46):e8240. doi: 10.1097/MD.0000000000008240.
Approximately 40% to 50% of gastrointestinal stromal tumor (GIST) patients will have recurrence or metastases after resection of the primary lesion, and the most common affected sites will be liver and peritoneum. Imatinib has been considered as the first-line therapy of metastatic GIST. Surgery for metastases is proposed when possible. Furthermore, there are controversies concerning hepatic resection and systemic tyrosin kinase inhibitors (TKIs). The therapeutic conditions and long-term outcome of GIST patients with liver metastases in northern China remain unknown.The clinical, pathological, and follow-up data of 144 GIST patients, who had liver metastases between June 1996 and June 2014 from 3 tertiary cancer centers in northern China, were reviewed.Thirty-two cases (22.2%) had hepatectomy with 23 (23/32, 71.9%) R0 resections and 9 (9/32, 28.1%) R1/R2 resections, respectively. Twenty-three patients were given imatinib postoperatively. Furthermore, 98 (68.1%) patients were given TKIs only to control disease progression, and sunitinib was considered after imatinib failure in 12 patients. The 1-, 3- and 5-year survival rate was 82%, 51%, and 24%, with a median overall survival of 48 months for all patients. Patients who had hepatic resection combined with TKIs had a tendency of improved outcome, and the median survival time was 89 months. This was in contrast to patients who received TKIs only, in which median survival time was 53 months. Patients who received imatinib plus sunitinib had a tendency of longer survival time, compared with patients who received imatinib only (not reached vs 50 months).TKIs combined with hepatic resection had a role in improving the outcome of GIST patients with liver metastases.
约40%至50%的胃肠道间质瘤（GIST）患者在原发灶切除后会出现复发或转移，最常见的受累部位是肝脏和腹膜。伊马替尼一直被视为转移性GIST的一线治疗药物。如有可能，建议对转移灶进行手术治疗。此外，关于肝切除和全身酪氨酸激酶抑制剂（TKIs）存在争议。中国北方GIST肝转移患者的治疗情况及长期预后尚不清楚。回顾了1996年6月至2014年6月期间来自中国北方3家三级癌症中心的144例发生肝转移的GIST患者的临床、病理及随访数据。32例（22.2%）患者接受了肝切除术，其中23例（23/32，71.9%）为R0切除，9例（9/32，28.1%）为R1/R2切除。23例患者术后接受了伊马替尼治疗。此外，98例（68.1%）患者仅接受TKIs以控制疾病进展，12例患者在伊马替尼治疗失败后改用舒尼替尼。所有患者的1年、3年和5年生存率分别为82%、51%和24%，总生存期中位数为48个月。接受肝切除联合TKIs治疗的患者预后有改善趋势，中位生存时间为89个月。这与仅接受TKIs治疗的患者形成对比，后者中位生存时间为53个月。与仅接受伊马替尼治疗的患者相比（未达到 vs 50个月），接受伊马替尼加舒尼替尼治疗的患者生存时间有延长趋势。TKIs联合肝切除对改善GIST肝转移患者的预后有作用。
