作者：石维坤，张信华，何裕隆

单位：中山大学附属第一医院 胃肠外科中心，广东 广州 510080

Authors:  Shi Weikun, Zhang Xinhua, He Yulong

Unit:  Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

胃肠间质瘤(GIST)是消化道中最常见的间叶源性肿瘤。对于局限性GIST,手术治疗是唯一的潜在治愈方法。对于进展期GIST,使用伊马替尼治疗可以显著改善预后。对进展期GIST实行手术治疗的最佳人选要满足以下条件:酪氨酸激酶抑制剂(TKIs)治疗后达到有效或稳定;更少的转移灶;更可能达到R0/R1切除;术后尽快恢复TKIs治疗。多灶进展的患者不太可能从手术获益。除了考虑患者的整体状态外,还需要根据患者KIT和PDGFRα的突变情况,设计多学科、个体化的治疗方案。

关键词：  胃肠间质瘤; 伊马替尼; 减瘤手术

Abstract：

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumors in the digestive tract. Surgery is the only potentially curative therapy for localized GIST. The prognosis of advanced GIST has increased substantially after the introduction of imatinib. The best candidates for surgery among patients with advanced GIST are those with stable or responding disease with tyrosine kinase inhibitors (TKIs) therapy, fewer metastatic foci, and possibility of R0/R1 resection. TKIs treatment should be resumed postoperatively. Patients with multifocal progressive disease are significantly worse and these patients are unlikely to benefit from surgery. Individualization of multidisciplinary treatments needs to be designed based on c-kitand PDGFRA mutations in addition to the patient’s status.

Key Words:  Gastrointestinal stromal tumor; Imatinib; Cytoreductive surgery