肝移植治疗肝脏转移性胃肠道间质瘤(附二例报告)

目的初步探讨肝移植对无法切除的肝脏转移性胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的疗效,并结合文献探讨其综合治疗策略。方法回顾性分析中山大学附属第一医院2例GIST术后肝转移病例行肝移植手术的临床资料。结果1例63岁女性因十二指肠间质瘤行胰十二指肠切除术,另1例46岁女性因小肠间质瘤行小肠部分切除术,分别于13年和5年后出现了无法切除的多灶性肝转移。2例均给予序贯伊马替尼和苏尼替尼治疗,并联合经动脉化疗栓塞治疗,分别经过2年及1年8个月治疗,无缓解,接受了肝移植手术,术后无严重并发症,病理证实为转移性GIST,术后均接受免疫抑制剂和酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)的治疗,分别随访31个月和24个月,未发现肿瘤复发或转移。结论肝移植可作为不可切除的肝转移性GIST病人治疗的一种选择,联合TKI靶向治疗在一定程度上可延长生存期,改善预后。

Liver transplantation for liver metastasis of gastrointestinal stromal tumor

Objective To explore the efficacy of liver transplantation and comprehensive treatment strategies for cases of metastatic gastrointestinal stromal tumors(GISTs) of liver. Methods The clinical data of two patients with metastatic GISTs of liver in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Results One 63-year-old woman who underwent pancreaticoduodenectomy(PD) due to a duodenal GIST13 years ago and another 46-year-old woman who had partial resection of small bowel due to small intestinal GIST 5 years ago,were both found unresectable multifocal metastases of liver.Two patients were both treated with sequential imatinib mesylate and sunitinib malate,combined with transarterial chemoembolization(TACE) for2years and1 year and 8 months respectively,and no remission was achieved.They both received liver transplantation successfully and recovered uneventfully.Metastatic GISTs were confirmed by postoperative pathological examination.Both cases were treated with immunosuppressive agents and TKI.There was no recurrence or metastasis during the period of 31- and 24-month follow-up respectively. Conclusion Liver transplantation might be an alternative option with a better prognosis for highly selected patients with unresectable metastatic GIST to the liver,and combined targeted therapy of TKI can prolong the survival and improve the prognosis.