胃肠道间质瘤的研究进展
|
摘要
胃肠道间质瘤(GIST)由梭形细胞或(和)上皮样细胞组成,可以发生在胃肠道的任何部位,无特异性临床症状。GIST的发病机制是Kit或PDGFRA基因的突变导致酪氨酸激酶受体的激活。评估GIST根治性切除的风险因素包括核分裂像、肿瘤的大小和部位。CT检查可以帮助判断肿瘤的部位及大小,超声内镜可以判断GIST生长的层面及GIST的大小和形状,对于内镜下切除GIST术前评估具有很大帮助。手术治疗包括内镜下切除、外科手术、内镜联合腹腔镜治疗。药物治疗包括新辅助治疗、辅助治疗等,酪氨酸激酶抑制剂新辅助治疗有利于切缘阴性(RO)切除,可以减少手术的并发症,手术切除GIST后服用酪氨酸激酶抑制剂可以增加患者生存期及降低转移率,对于GIST进展期患者,在接受酪氨酸激酶抑制剂治疗后,可以重新再进行手术前评估。PET-CT/CT/MRI检查有助于评估早期转移病灶及复发情况。
Gastrointestinal stromal tumors(GIST) consist of spindle cells or/and epithelioid cells, which may arise throughout the entire gastrointestinal tract without specific clinical symptoms. The pathogenesis of GIST is the activation of tyrosine kinase receptors by mutations in Kit or PDGFRA genes. Risk factors for radical resection of GIST include mitosis, size and location of tumors. CT examination can help to determine the location and size of tumors. Ultrasound endoscopy can determine the growth level of GIST and the size and shape of GIST. It is very helpful for preoperative evaluation of endoscopic resection of GIST. Surgical treatment includes endoscopic resection, surgery, endoscopy combined with laparoscopic treatment. Drug therapy includes neoadjuvant therapy, adjuvant therapy and so on. Neoadjuvant therapy with tyrosine kinase inhibitors is beneficial to margin-negative(RO) resection and can reduce the complications of surgery. Tyrosine kinase inhibitors can increase survival and reduce metastasis after surgical resection of GIST. For patients with progressive stage GIST, after treatment with tyrosine kinase inhibitors, preoperative evaluation can be re-evaluated. PET-CT/CT/MRI examination is helpful in evaluating early metastasis and recurrence.
Gastrointestinal stromal tumors(GIST) consist of spindle cells or/and epithelioid cells, which may arise throughout the entire gastrointestinal tract without specific clinical symptoms. The pathogenesis of GIST is the activation of tyrosine kinase receptors by mutations in Kit or PDGFRA genes. Risk factors for radical resection of GIST include mitosis, size and location of tumors. CT examination can help to determine the location and size of tumors. Ultrasound endoscopy can determine the growth level of GIST and the size and shape of GIST. It is very helpful for preoperative evaluation of endoscopic resection of GIST. Surgical treatment includes endoscopic resection, surgery, endoscopy combined with laparoscopic treatment. Drug therapy includes neoadjuvant therapy, adjuvant therapy and so on. Neoadjuvant therapy with tyrosine kinase inhibitors is beneficial to margin-negative(RO) resection and can reduce the complications of surgery. Tyrosine kinase inhibitors can increase survival and reduce metastasis after surgical resection of GIST. For patients with progressive stage GIST, after treatment with tyrosine kinase inhibitors, preoperative evaluation can be re-evaluated. PET-CT/CT/MRI examination is helpful in evaluating early metastasis and recurrence.
引文
[1] Hirota S,Isozaki K,Moriyama Y,et al.Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors[J].Science,1998,279(5350):577-580.
[2] Sevinc A,Camci C,Yilmaz M,et al.The diagnosis of C-kit negative GIST by PDGFRA staining:clinical,pathological,and nuclear medicine perspective[J].Onkologie,2007,30(12):645-648.
[3] Von Mehren M,Joensuu H.Gastrointestinal stromal tumors[J].JClin Oncol,2018,36(2):136-143.
[4] Feng F,Tian Y,Liu Z,et al.Clinicopathologic features and clinical outcomes of esophageal gastrointestinal stromal tumor:evaluation of a pooled case series[J].MMedicine,2016,95(2):e246.
[5] Nishida T,Goto O,Raut CP,et al.Diagnostic and treatment strategy for small gastrointestinal stromal tumors[J].Cancer,2016,122(20):3110-3118.
[6] Heinrich MC,Corless CL,Demetri GD,et al.Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor[J].J Clin Oncol,2003,21(23):4342-4349.
[7] Mearadji A,den Bakker MA,van Geel AN,et al.Decrease of CD117expression as possible prognostic marker for recurrence in the resected specimen after imatinib treatment in patients with initially unresectable gastrointestinal stromal tumors:a clinicopathological analysis[J].Anticancer Drugs,2008,19(6):607-612.
[8] Liegl B,Hornick JL,Corless CL,et al.Monoclonal antibody DOG1.1shows higher sensitivity than KIT in the diagnosis of gastrointestinal stromal tumors,including unusual subtypes[J].Am J Surg Pathol,2009,33(3):437-446.
[9] Vasconcelos RN,Dolan SG,Barlow JM,et al.Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors[J].Abdominal Radiology,2017,42(5):1365-1373.
[10] Balde AI,Chen T,Hu Y,et al.Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors:a propensity score-matched study[J].Surg Endosc,2017,31(2):843-851.
[11] An W,Sun PB,Gao J,et al.Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors:a retrospective cohort study[J].Surg Endosc,2017,31(11):4522-4531.
[12]肖惠,吴艳烈.腹腔镜、胃镜联合手术在胃间质瘤临床治疗中的应用[J].临床外科杂志,2017,25(12):902-904.
[13]何裕隆,徐建波.胃肠间质瘤多学科综合治疗协作组诊疗模式专家共识[J].中国实用外科杂志,2017,37(1):39-41.
[14] Rossi S,Congedo T,Ricci R,et al.Is surgery mandatory in locally advanced gastrointestinal stromal tumors after imatinib? A case report and literature review[J].J gastrointest Oncol,2017,8(1):E4-E9.
[15] Lin JX,Chen QF,Zheng CH,et al.Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk.gastrointestinal stromal tumor?A study based on long-term follow-up[J].J Cancer Res Clin Oncol,2017,143(4):727-734.
[16] Joensuu H,Wardelmann E,Sihto H,et al.Effect of KIT and PDGFR A mutations on survival in patients with gastrointestinal stromal tumorr treated with adjuvant imatin ib:an exploratory analysis of arandomized clinical trial[J].Jama Oncolog,2017,3(5):602-609.
[17]杨弘鑫,张波,沈朝勇,等.伊马替尼治疗晚期及高危胃肠道间质瘤的临床疗效与安全性分析[J].中国普通外科杂志,2017,4(26):437-442.
[18]任莉莉.CT及MRI检查诊断胃肠道间质瘤的价值分析[J].新疆医学,2017,47(2):147-149.
[19]中国临床肿瘤学会胃肠间质瘤专家委员会.中国胃肠间质瘤诊断治疗共识(2018年版)[J].肿瘤综合治疗电子杂志,2018,4(1):31-43.
[2] Sevinc A,Camci C,Yilmaz M,et al.The diagnosis of C-kit negative GIST by PDGFRA staining:clinical,pathological,and nuclear medicine perspective[J].Onkologie,2007,30(12):645-648.
[3] Von Mehren M,Joensuu H.Gastrointestinal stromal tumors[J].JClin Oncol,2018,36(2):136-143.
[4] Feng F,Tian Y,Liu Z,et al.Clinicopathologic features and clinical outcomes of esophageal gastrointestinal stromal tumor:evaluation of a pooled case series[J].MMedicine,2016,95(2):e246.
[5] Nishida T,Goto O,Raut CP,et al.Diagnostic and treatment strategy for small gastrointestinal stromal tumors[J].Cancer,2016,122(20):3110-3118.
[6] Heinrich MC,Corless CL,Demetri GD,et al.Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor[J].J Clin Oncol,2003,21(23):4342-4349.
[7] Mearadji A,den Bakker MA,van Geel AN,et al.Decrease of CD117expression as possible prognostic marker for recurrence in the resected specimen after imatinib treatment in patients with initially unresectable gastrointestinal stromal tumors:a clinicopathological analysis[J].Anticancer Drugs,2008,19(6):607-612.
[8] Liegl B,Hornick JL,Corless CL,et al.Monoclonal antibody DOG1.1shows higher sensitivity than KIT in the diagnosis of gastrointestinal stromal tumors,including unusual subtypes[J].Am J Surg Pathol,2009,33(3):437-446.
[9] Vasconcelos RN,Dolan SG,Barlow JM,et al.Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors[J].Abdominal Radiology,2017,42(5):1365-1373.
[10] Balde AI,Chen T,Hu Y,et al.Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors:a propensity score-matched study[J].Surg Endosc,2017,31(2):843-851.
[11] An W,Sun PB,Gao J,et al.Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors:a retrospective cohort study[J].Surg Endosc,2017,31(11):4522-4531.
[12]肖惠,吴艳烈.腹腔镜、胃镜联合手术在胃间质瘤临床治疗中的应用[J].临床外科杂志,2017,25(12):902-904.
[13]何裕隆,徐建波.胃肠间质瘤多学科综合治疗协作组诊疗模式专家共识[J].中国实用外科杂志,2017,37(1):39-41.
[14] Rossi S,Congedo T,Ricci R,et al.Is surgery mandatory in locally advanced gastrointestinal stromal tumors after imatinib? A case report and literature review[J].J gastrointest Oncol,2017,8(1):E4-E9.
[15] Lin JX,Chen QF,Zheng CH,et al.Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk.gastrointestinal stromal tumor?A study based on long-term follow-up[J].J Cancer Res Clin Oncol,2017,143(4):727-734.
[16] Joensuu H,Wardelmann E,Sihto H,et al.Effect of KIT and PDGFR A mutations on survival in patients with gastrointestinal stromal tumorr treated with adjuvant imatin ib:an exploratory analysis of arandomized clinical trial[J].Jama Oncolog,2017,3(5):602-609.
[17]杨弘鑫,张波,沈朝勇,等.伊马替尼治疗晚期及高危胃肠道间质瘤的临床疗效与安全性分析[J].中国普通外科杂志,2017,4(26):437-442.
[18]任莉莉.CT及MRI检查诊断胃肠道间质瘤的价值分析[J].新疆医学,2017,47(2):147-149.
[19]中国临床肿瘤学会胃肠间质瘤专家委员会.中国胃肠间质瘤诊断治疗共识(2018年版)[J].肿瘤综合治疗电子杂志,2018,4(1):31-43.