Nakata Kazuaki, Masuzawa Toru, Katsuyama Shinsuke, Sugimura Keijiro, Ikeshima Ryo, Kawai Kenji, Hiraki Masayuki, Shinke Go, Katsura Yoshiteru, Ohmura Yoshiaki, Hata Taishi, Takeda Yutaka, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1429-1430.
A 63-year-old female patient underwent resection of a gastrointestinal stromal tumor(GIST)at the age of 48 years. After surgery, she had adjuvant chemotherapy. She had been recurrence-free for 10 years. Two years after completion of medical therapy, local peritoneal recurrence of GIST was observed, and medical therapy with imatinib was restarted. The response was good, but 1 year after resumption of medical therapy, progression was observed, and imatinib resistance was suspected, and recurrent tumor resection was performed. After the reoperation, the patient continued medical treatment with imatinib. Two years after the reoperation, a tumor suspected to be recurrent was found in the abdominal cavity. Tumor resection was performed. Histopathological examination revealed c-kit and CD34 positivity, leading to a diagnosis of recurrence of GIST. Imatinib is the mainstay of treatment in patients with recurrent GISTs, and sunitinib may be considered if the patient becomes resistant to imatinib, or surgical treatment may be considered if the lesion can be resected. In this study, we report a case of GIST with peritoneal dissemination in which imatinib therapy was continued after surgery, but the disease recurred twice. We investigate the prognostic value of continued imatinib therapy after surgical resection of locally recurrent GIST.
一名63岁女性患者在48岁时接受了胃肠道间质瘤（GIST）切除术。术后，她接受了辅助化疗。她已无复发存活10年。在完成药物治疗两年后，观察到GIST局部腹膜复发，于是重新开始使用伊马替尼进行药物治疗。反应良好，但在恢复药物治疗1年后，观察到病情进展，怀疑出现伊马替尼耐药，遂进行复发性肿瘤切除术。再次手术后，患者继续使用伊马替尼进行药物治疗。再次手术后两年，在腹腔发现疑似复发的肿瘤，进行了肿瘤切除术。组织病理学检查显示c-kit和CD34呈阳性，确诊为GIST复发。伊马替尼是复发性GIST患者的主要治疗药物，如果患者对伊马替尼耐药，可考虑使用舒尼替尼，或者如果病变可以切除，可考虑手术治疗。在本研究中，我们报告了一例GIST腹膜播散病例，该患者术后继续接受伊马替尼治疗，但疾病复发了两次。我们研究了局部复发性GIST手术切除后继续使用伊马替尼治疗的预后价值。
