Gastrointestinal stromal tumors (GISTs), 10-year experience: Patterns of failure and prognostic factors for survival of 127 patients

BackgroundGastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) and are believed to originate from the interstitial cell of Cajal. Management of GIST has evolved very rapidly in the last decade.AimTo report our surgical experience in the treatment of GIST patients, to evaluate the prognostic factors and to discuss some controversial issues about the role of target therapy.Patients and methodsOne hundred and twenty seven consecutive patients who underwent surgical resection for GISTs at Nasser Institute (98 patients) and NCI, Cairo University (29 patients) from January 2000 to December 2009 were reviewed retrospectively. The clinical and pathological features of patients were collected. Also data about treatment variables, patterns of failure and factors that predict survival were collected and analyzed.ResultsOf the 127 patients, 81 (64%) had primary disease without metastasis, 11 (9%) had metastatic lesions at presentation, and 35 (27%) presented with recurrence (isolated, metastasis or both). Patients with primary disease underwent complete resection of gross disease. The 5-year overall survival was 53.4% and disease free survival (DFS) was 46.5%. The median DFS was 43.0 months (95% CI: 21.2–64.9). On multivariate analysis, survival was affected by mode of presentation, gastric origin and tumor size. Failures after resection were predominantly intra-abdominal (original site, peritoneal, and liver), and rarely lungs.ConclusionSurgical resection is the mainstay of treatment of GIST. Tumor size and gastric origin were the predicators for DFS in patients presenting with primary disease.     

Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era

BACKGROUND:

Before the advent of tyrosine kinase inhibitors (TKIs), surgical resection was the primary treatment for hepatic gastrointestinal stromal tumor (GIST) metastases. Although TKIs have improved survival in the metastatic setting, outcomes after multimodal therapy comprised of hepatectomy and TKIs for GIST are unknown. The objective of this study was to determine whether combination therapy for hepatic GIST metastases is associated with improved overall survival compared with reported outcomes from surgery or TKI therapy alone.

METHODS:

Demographics, clinicopathologic tumor characteristics, treatments, and outcomes of patients who underwent hepatic resection at 3 high‐volume centers from 1995 to 2010 were reviewed.

RESULTS:

In total, 39 patients underwent hepatectomy for metastatic GISTs, and 27 patients received postoperative TKI therapy. At a median follow‐up of 39.7 months, 23 patients (59%) experienced recurrence at a median of 18 months. The 1‐year, 2‐year, and 3‐year overall survival rates were 96.7%, 76.8%, and 67.9%, respectively. Median survival was not reached at 5 years. The rates of severe complication and mortality were 10.2% (4 patients) and 2.5% (1 patient), respectively. When controlling for confounders, postoperative TKI therapy was associated with improved survival (hazard ratio, 0.04; 95% confidence interval, 0.01‐0.50; P = .006), and extrahepatic disease was associated with worse survival (hazard ratio, 9.51; 95% confidence interval, 1.63‐55.7; P = .012).

CONCLUSIONS:

Overall survival after combination therapy exceeded previous reports for the treatment of metastatic GIST with hepatic resection or TKI therapy alone and was significantly enhanced by postoperative TKI therapy. The results from this study support findings that combination therapy for GIST liver metastases comprised of surgical resection and TKI therapy is more effective than surgery or TKI therapy alone. Cancer 2012;3571–3578. © 2011 American Cancer Society.     

Prognostic Factors of Gastrointestinal Stromal Tumors: A Single Institutional Retrospective Experience with Surgical Management over 20 Years

OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor (GIST) after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients with GISTs who underwent surgery between 1988 and 2007 were retrospectively reviewed. The predic-tive factors for the survival of these patients were identi. ed using multivariate analysis. RESULTS In the 327 tumors, 152 (46.5%) were located in the stomach, 89 (27.2%) in the small intestine, 33 (10.1%) in the colon and rectum, and 43 (13.1%) in other sites including the omentum and mesentery. The 3-year and 5-year overall survival rates of the 327 GIST patients were 74.4% and 62.7%, respectively, and univariate survival analysis demonstrated that factors, such as tumor size, mitotic index, NIH categories, Ki-67 index, tumor location, surgical margins, tumor bleeding, and tumor necrosis have significant effect on survival of the patients (P < 0.05). Multivariate analysis demonstrated that the NIH categories, surgical margins, and Ki-67 index were independent prognostic factors for the survival rate. In the group of patients with postoperative recurrence or metastasis, the median survival time of patients who did not receive imatinib treatment was 30 months and that of patients who received imatinib treatment was 59 months. Their 5-year survival rates were 16.4% and 39.4%, respectively, and the difference was statistically significant (P = 0.017). CONCLUSION Complete resection is the .rst choice of treat-ment for GISTs. It is reasonable to evaluate the prognosis of resect-able GISTs and guide the adjunctive therapy with NIH categories and Ki-67 index. Imatinib treatment can signi.cantly increase the survival rate of patients with recurrent and metastatic GISTs.     

Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas

BACKGROUND: In recent years, imatinib mesylate (STI 571), a tyrosine kinase inhibitor, has shown short-term clinical usefulness for gastrointestinal stromal tumor or gastrointestinal leiomyosarcoma (GIST). The value of surgical resection, including hepatectomy, for metastatic GIST remains unknown. Our aim was to evaluate the outcome of surgical resection, including hepatectomy, for metastatic GIST at a single institute. METHODS: Eighteen patients who underwent hepatectomy for metastatic GIST were identified and the clinicopathological data of these patients were analyzed retrospectively. RESULTS: The primary site of GIST included stomach in 10, duodenum in five, ileum in two and esophagus in one patient. A hemihepatectomy or greater resection was undertaken in eight patients. Six patients underwent simultaneous resection for primary and hepatic disease. There was no in-hospital mortality in this series. The post-hepatectomy 3- and 5-year survival rates were 63.7 and 34.0% respectively, with a median of 36 (17-227) months. Recurrence after the initial hepatectomy was documented in 17 patients (94%), and metastatic mass of the remnant liver developed in 15 of these 17 patients (88%). Three patients survived >5 years after the initial hepatectomy who underwent multiple surgical resections during this period. No clinicopathological characteristic was a significant predictive factor for survival. CONCLUSIONS: Multiple surgical resections, including hepatectomy, may contribute to important palliation in selected patients with metastatic GIST. Surgical cure seems to be difficult due to the high frequency of repeat metastasis to various sites. Therefore, adjuvant therapy must be required in the treatment of metastatic GIST.     

Multivariate Analysis of Clinical Prognostic Factors in Children with Intracranial Ependymomas

The optimal postoperative management of pediatric intracranial ependymomas is controversial. We analyzed clinical prognostic factors for their influence on outcome in such children. Our retrospective series included 15 with supratentorial and 28 with infratentorial tumors. Twenty ependymomas were grade II, and 23 were anaplastic. Complete resection was performed in 18 patients, incomplete resection in 19, and stereotactic biopsy in 6. Radiotherapy was done in 31 patients and chemotherapy in 13. The surviving patients have been followed 8-232 months (median: 69 months). The median survival time was 30 months, and 5-year overall survival and progression-free survival rates were 53.9% and 45.9%, respectively. By tumor site: supratentorial, 56.6% and 50.9%; infratentorial, 52.3% and 42.5%. Multivariate analysis identified complete resection (5-year progression-free survival, 71.8%) and age <3 years old as significant favorable and adverse prognostic features (relative risk, 2.59; 95% CI, 1.05-6.38), respectively. Twenty-six children relapsed 1-107 months after diagnosis (median: 12 months). Relapses were local in 22 cases, and combined local and distant in three cases. Only one of 15 patients with supratentorial tumors developed isolated spinal metastasis. Failure at the primary site is the major obstacle to improve cure rates. The extent of surgical resection and age were the only statistically significant prognostic factors.     

Survival Outcomes of Liver Metastasectomy in Colorectal Cancer Cases: A Single-Center Analysis in Turkey

Background: The purpose of this study was to analyze our series of liver resections for metastatic colorectal carcinoma (mCRC) to determine prognostic factors affecting survival and to evaluate the potential roles of neoadjuvant or adjuvant chemotherapy. Materials and Methods: Ninety-nine patients who underwent metastasectomy for liver metastases due to colorectal cancer at the Department of Medical Oncology, 9 Eylul University Hospital between 1996 and 2010 were evaluated in this study. The patients were followed through July 2013. Demographic, perioperative, laboratory, radiological and chemotherapy as well as survival data were obtained by retrospective chart review. Results: In 47 (47.5%) patients, liver metastases were unresectable at initial evaluation; the remaining 52 (52.5%) patients exhibited resectable liver metastases. Simultaneous hepaticresection was applied to 52 (35.4%) patients with synchronous metastasis, whereas 5 (64.5%) patients underwent hepatic resection after neoadjuvant chemotherapy. Forty-two patients with metachronous metastasis underwenthepatic resection following neoadjuvant chemotherapy. R0 resection was obtained in 79 (79.8%) patients. A second hepatectomy was performed in 22 (23.2%) patients. Adjuvant chemotherapy was given to 85 (85.9%) patients after metastasectomy. The median disease-free and overall survivals after initial metastasectomy were 12 and 37 months, respectively, the 1-year, 3-year and 5-year disease-free survival (DFS) and overall survival (OS) rates being 46.5%, 24.3% and 17.9%and 92.3%, 59.0% and 39.0%, respectively. On multivariate analysis, the primary tumor site, tumor differentiation, resection margin and DFS were independent factors predicting better overall survival. Conclusions: In selected cases, hepatic metastasectomy for mCRC to the liver can result in long-term survival. Neoadjuvant chemotherapy did not exert a positive effect on DFS or OS. Adjuvant chemotherapy also did not appear to impact DFS and OS.     

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors.METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011.RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1.CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.     

An audit of surgical management of gastrointestinal stromal tumours (GIST)

AimTo analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis.MethodsA retrospective review (1993–2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1–132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis.ResultsGIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis (p<0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-up 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p<0.001).ConclusionPrognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment.Complete surgical resection offers good chance of cure for low grade GIST, while for high grade GIST surgery alone is not sufficient. The presented grading system could be used to identify patients who may benefit of adjuvant treatment with imatinib mesylate after GIST resection.     

Preoperative imatinib facilitates complete resection of locally advanced primary GIST by a less invasive procedure

Complete resection is the most effective therapy for gastrointestinal stromal tumors (GISTs). Complete resection of locally advanced primary GIST by less invasive procedure is usually difficult at initial diagnosis. Imatinib has been successful in treating locally advanced and metastatic GIST and this report shares the experiences in preoperative use of imatinib for patients with locally advanced primary GISTs. The procedure of treatment and completeness of resection were retrospectively accessed for locally advanced primary GIST. Disease-free survival (DFS) and overall survival (OS) after resection were analyzed. Thirteen patients were treated with imatinib preoperatively. All patients received surgical resection after a median imatinib treatment of 7 months when most tumors shrunk. All patients achieved R0 resection without tumor rupture. Two patients received an en-bloc multivisceral resection for the invasion of surrounding organs and 3 patients underwent Mile’s operation for a low rectal tumor. Eleven patients were disease-free. Median DFS or OS had not been reached, while 1- and 3-year DFS were estimated to be 92.3 and 76.9 %, respectively. 1- and 3-year OS were both estimated to be 100 %. Preoperative use of imatinib is useful in locally advanced primary GIST by downsizing the tumor in most patients and facilitating complete resection through less invasive procedures without tumor rupture.     

Whole-brain radiotherapy and tumor bed radiosurgery following resection of solitary brain metastases

A standard approach to solitary brain metastases is resection followed by whole-brain radiation therapy (WBRT). Despite WBRT, the tumor bed remains a common site of failure. We reviewed outcomes following adjuvant WBRT with tumor bed radiosurgery (SRS). We retrospectively identified patients having undergone neurosurgical resection of a single brain metastasis followed by adjuvant WBRT and tumor bed SRS. SRS dose selection was independent of target volume (10 Gy peripheral dose). Outcomes were calculated actuarially. Patients were censured for local control at the time of last imaging. From 2005 to 2008, 27 patients were treated with WBRT and tumor bed SRS. Median age was 58.7 years, median KPS 80%. The primary malignancy was non-small cell lung cancer in 70%. Median follow-up was 9.7 months. Following the combination of surgery, WBRT and SRS the median overall survival was 17.6 months. Actuarial 2-year local control was 94%. The SRS boost was well tolerated with one patient (4%) requiring reoperation for symptomatic radiation necrosis 16 months post treatment. Radiosurgery can be safely added to WBRT as an adjuvant treatment following resection of a single brain metastasis. In our retrospective series, this combination treatment produced a high rate of local control.     

原发性胃肠道间质瘤的多因素Cox模型分析

 目的　分析胃肠道间质瘤（GIST）的临床特征、治疗效果及其影响因素。方法　复习216例原发性GIST临床资料并加以随访进行Cox回归模型分析。结果　全组1、2、3、4、5年生存率分别为94.4 ％（204／216）、90.2 ％（129／143）、88.3 ％（68／77）、87.5 %（35／40）和85.0 %（17／20）。年龄、发生部位、完整切除、肿瘤是否破裂、辅助治疗、是否复发、肿瘤病理核分裂象、最大径等因素对GIST患者预后生存率的影响有显著性意义（P＜0.05）;并且随着影响因素变量值增大,死亡的风险值增高。其中完整切除对患者的预后起着决定性的作用。性别、CD117、是否活检、内镜黏膜是否糜烂、手术切缘等对预后生存率影响无显著性意义（P＞0.05）。术后辅助治疗可明显提高患者生存率,尤其对于高危险度患者。结论　GIST仍以外科治疗为主,其手术方式的选择更多取决于肿瘤的部位和大小,完整切除或扩大切除能提高生存率。年龄、发生部位、完整切除、肿瘤是否破裂、辅助治疗、术后是否复发、肿瘤病理核分裂象、最大径等是影响预后的重要因素,有利于指导临床规范化治疗。     

Prognostic factors affecting the clinical outcome of adenoid cystic carcinoma of the head and neck

BACKGROUND: Adenoid cystic carcinoma (ACC) is an uncommon tumor, constituting approximately 10% of all head and neck tumors. Classically, ACC has been described as a tumor with indolent, but persistent and recurrent, growth and late onset of metastases, leading eventually to death. This study assessed the prognostic factors affecting the clinical outcome in patients with ACC in the head and neck region. METHODS: We performed a retrospective study of 42 patients who underwent primary tumor resection or radiotherapy with curative intent and evaluated the clinical parameters, treatment and clinical outcomes. RESULTS: Forty-two patients (18 males and 24 females with a median age of 65 years) received curative treatment. The overall 3- and 5-year survival was 87.4% and 55.3%, respectively, whereas the 3- and 5-year disease-free survival was 64.3% and 36.1%, respectively. Of the 32 patients in whom recurrence could be evaluated, 18 (56.3%) developed distant metastases, with the lung (72.2%) being the most common site. Perivascular invasion influenced metastasis to the lung with borderline significance (P = 0.053). The recurrence rate was higher (P = 0.045) in patients with high-grade tumor. The status of lymph node metastasis was significantly associated with overall survival (P = 0.030). CONCLUSIONS: High tumor grade and lymph node involvement were predictive of recurrence and overall survival, respectively. Despite aggressive treatment, it seems to be impossible to prevent the development of distant metastasis. Therefore, more research is needed to identify molecular biomarkers that predict the clinical outcome and to develop effective treatment for patients with ACC.     

胃肠道间质瘤32例临床分析

目的 :提高对胃肠道间质瘤 (gastrointestinalstromaltumor ,GIST)的认识和诊治水平。方法 :回顾分析总结 32例GIST的临床资料。结果 :患者平均年龄 4 2 .7岁 ,男女比为 17∶15。病灶均为单发 ,部位以胃及小肠最多见 ,分别为 13例 ( 4 0 .6% )和 15例 ( 4 6.9% )。病理诊断良性 2 1例 ( 65.6% )、交界性5例 ( 15.6% )、恶性 6例 ( 18.8% )。结合肿瘤临床生物学行为 ,重新划分为GIST良性 18例 ( 56.3% )、交界性 4例 ( 12 .5% )、恶性 10例 ( 31.3% )。 32例均获手术切除 ,术后复发 2例 ,肝转移 4例 ,死亡 4例。结论 :GIST是一类具有恶性倾向的肿瘤 ,局部切除是足够而有效的治疗。术后应长期严密随访 ,对复发和 /或转移者应持积极态度 ,多次姑息切除 ,辅以TACE可望延长病人生存期。     

Survival of Brain Metastatic Patients in Yazd,Iran

Background: Brain metastasis occurs when cancerous cells come from a known (or sometimes an unknown)primary tumor to the brain and implant and grow there. This event is potentially lethal and causes neurologicsymptoms and signs. These patients are treated in order to decrease their neurologic problems, increase qualityof life and overall survival. Materials and Methods: In this study we evaluated clinical characteristics of 206patients with brain metastases referred to our center from 2004 to 2011. Results: The mean age was 53.6 years.The primary tumors were breast cancer (32%), lung cancer (24.8%), lymphoma (4.4%), sarcoma (3.9%),melanoma (2.9%), colorectal cancer (2.4%) and renal cell carcinoma (1.5%). In 16.5% of the patients, brainmetastasis was the first presenting symptom and the primary site was unknown. Forty two (20.4%) patients hada single brain metastasis, 18 patients (8.7%) had two or three lesions, 87 (42.2%) patients had more than threelesions. Leptomeningeal involvement was seen in 49 (23.8%) patients. Thirty five (17%) had undergone surgicalresection. Whole brain radiation therapy was performed for all of the patients. Overall survival was 10.1 months(95%CI; 8.65-11.63). One and two year survival was 27% and 12% respectively. Conclusions: Overall survivalof patients who were treated by combination of surgery and whole brain radiation therapy was significantlybetter than those who were treated with whole brain radiation therapy only [13.8 vs 9.3 months (p=0.03)]. Age,sex, primary site and the number of brain lesions did not show significant relationships with overall survival.     

胃肠道间质瘤肝转移患者肝转移和预后的影响因素分析--基于SEER数据库的回顾性研究

目的探讨胃肠道间质瘤肝转移患者肝转移和预后的影响因素。方法收集监测、流行病学、最终结果(SEER)数据库中2010-2015年的2684例胃肠道间质瘤患者的病历资料,根据是否发生肝转移分为肝转移组(191例)和非肝转移组(2493例),评估临床特征与胃肠道间质瘤肝转移及预后的关系。结果Logistic回归分析结果显示肿瘤分化差(OR=1.31,95%CI=1.09~1.59,P=0.005)、肿瘤大小﹥5 cm(OR=2.55,95%CI=1.78~3.65,P﹤0.01)和淋巴结转移(OR=2.39,95%CI=1.84~3.12,P﹤0.01)增加胃肠道间质瘤肝转移发生风险。肝转移患者生存时间明显短于非肝转移患者,差异有统计学意义(P﹤0.01)。肿瘤大小﹥5 cm(HR=1.881,95%CI=1.432~2.469,P=0.000)、淋巴结转移(HR=1.326,95%CI=1.031~1.706,P=0.028)、肝转移(HR=2.090,95%CI=1.615~2.703,P=0.000)是胃肠道间质瘤患者死亡风险较高的预后因素。亚组分析结果显示,原发部位在胃、种族为白种人和黑种人的胃肠道间质瘤肝转移患者的预后较差(P﹤0.05)。结论肿瘤分化差、肿瘤大小﹥5 cm、淋巴结转移是胃肠道间质瘤肝转移发生的易感因素;肿瘤大小﹥5 cm、淋巴结转移、肝转移为影响胃肠道间质瘤患者预后的危险因素;肝转移是原发部位在胃的胃间质瘤患者预后的危险因素,也是种族为白种人和黑种人的胃肠道间质瘤患者预后的危险因素。发生肝转移患者的总生存较差。对于发生肝转移的高危患者,在治疗和随访过程中应加强肝转移的相关检查,采取积极的综合治疗手段。     

35例颅内血管外皮细胞瘤预后的临床分析

目的:探讨总结中枢神经系统血管外皮细胞瘤（HPCs）临床治疗效果和预后。方法:回顾性分析35例HPCs的病例资料,均在显微镜下完成手术治疗,通过统计学方法分析影响其预后的关键因素。结果:所有患者确诊HPC后平均存活时间是82.4个月,1年,5年,10年总存活率分别为100%,93.8%和72.4%。13例（37.1%）患者首次手术后肿瘤复发。复发的平均时间是65.4个月,1年,5年,10年肿瘤无进展生存率分别为99%,49%,31%。3例患者发生颅外转移。患者接受任何形式的放射治疗与未接受放射治疗的患者相比,均没有延长总存活时间（P=0.22）,但延长了肿瘤无进展生存时间（P=0.04）。肿瘤直径≥6 cm和肿瘤侵犯静脉窦的患者比肿瘤直径<6 cm 和未侵犯静脉窦的复发更早（P<0.05）。结论:手术切除联合放疗可以阻止肿瘤进展,但不能延长患者总存活率。最大程度的肿瘤切除可以提高患者总存活率（P<0.05）。间变型HPC患者总存活率低,肿瘤无进展生存时间短（P<0.05）。     

18例直肠间质瘤的诊治分析

目的:直肠间质瘤（Gastrointestinal stromal tumour,GIST）是相对少见的疾病,缺少统一的治疗规范。本研究探讨直肠间质瘤的临床特点、诊断及治疗方法。方法:对中南大学湘雅医院2002年1 月～2009年4 月间收治的18例直肠GIST的临床资料、治疗方法及结果进行回顾性分析。结果:直肠GIST的临床表现无特异性,多表现为血便或大便次数增多。CT或MRI 显示肿块边界清楚,瘤内有出血坏死及无淋巴结肿大。18例标本免疫组化检测CD117 和CD34阳性率均100% 。低危险性和极低危险性共8 例,占44.4% 。全组均经手术治疗,行局部切除12例,直肠前切除术（Dixon）3 例,腹会阴联合切除术（Miles）3 例。术前以伊马替尼新辅助化疗3 例,均达部分缓解（partial response,PR）,然后均行局部切除。随访1～84个月,5 例患者复发转移,其中3 例行伊马替尼治疗,病情稳定。另外2 例未接受伊马替尼治疗,死亡1 例,另1 例反复局部切除后行Miles手术。局部切除组与Miles组的无复发生存时间分别为（75.0 ± 8.4）个月和（26.0 ± 11.1）个月（P=0.023）。 结论:直肠GIST的治疗方法应有别于直肠癌,需要制定个体化的外科治疗方案。对大部分低危险性的患者可通过各种手术路径行局部切除而达到满意效果。伊马替尼新辅助化疗的应用,可使部分直肠GIST患者获得保肛机会。      

41例复发转移恶性黑色素瘤治疗结果分析

本文共选择在外院经１次以上治疗后又转移复发的恶性黑色瘤４１例。全组中位生存时间２０．２个月，２年生存率５３．６％，５年生存率４．８％。手术结合瘤苗治疗２７例，单纯手术治疗１４例，前者中位生存时间明显长于后者，３４．３个月和１７．５个月（Ｐ＝０．０００１）。全组完全数据３３例，截尾数据８例（８０．４８％，１９．５％）。肿瘤患者的年龄、性别、大小及肿瘤部位在２组中的分布无差别（Ｐ＝０．９９，Ｐ＝０．１９，Ｐ＝０．５７）。在生存分布上下列诸因素间无差异：年龄Ｐ＝０．４３，性别Ｐ＝０．４，部位Ｐ＝０．７２。结果分析显示恶性黑色素瘤患者生存时间与肿瘤的大小及是否使用瘤苗有关。     

16例巨大型胃肠间质瘤手术治疗分析

目的：通过对巨大型胃肠间质瘤（GIST）的诊断和手术方式进行探索,为临床治疗巨大型 GIST 提供新思路。方法对16例巨大型 GIST 患者一般资料、影像学资料、手术方式、随访指标进行回顾性调查,并进行统计学分析。结果11例服用甲磺酸伊马替尼患者无复发生存期1 a 以上,而5例未服用伊马替尼治疗患者1 a 内复发,中位无复发生存期为33个月。COX 多因素分析显示,肿瘤部位、术中肿瘤有无破裂、是否使用伊马替尼治疗与患者预后有关（P <0.05）,可作为患者预后的独立因素。结论巨大型 GIST 在选择手术时,应遵循术前影像学评估、术前服用甲磺酸伊马替尼治疗缩小肿瘤和手术切除时边缘切净为3大原则,这对于改善患者预后和延长生存期有益。     

Systemic treatment of patients with gastrointestinal stromal tumor: Current status and future opportunities

Imatinib mesylate is considered the standard first-line systemic treatment for patients with advanced gastrointestinal stromal tumor (GIST). Results from recent research have expanded the knowledge of tyrosine kinase inhibitors in management of GIST. In the setting of unresectable and metastatic GIST, long-term follow-up of the B2222 study showed that imatinib 400 and 600 mg/d produced objective responses in 68% of patients and clinical benefit in 84%; it also extended median survival from 19 months in historical controls to 57 months. The MetaGIST analysis in two large phase 3 trials consisting of more than 1600 patients with metastatic and/or unresectable GIST showed that imatinib 800 mg/d compared with the standard 400-mg/d dose conferred a progression-free survival advantage in patients with KIT exon 9 mutations but not in other subpopulations. The higher starting dose does not significantly improve overall survival. The BFR14 trial demonstrated that interrupting imatinib is associated with a high risk of rapid disease progression. For patients with imatinib-intolerant or imatinib-resistant GIST, sunitinib or a variety of investigational agents, including the next-generation kinase inhibitor nilotinib, may be viable options for achieving disease control. In the setting of primary localized GIST, function- sparing surgical resection is the standard treatment approach, but some patients may be at substantial risk of disease recurrence and metastasis depending on tumor size, mitotic count, and possibly other factors. Initial results from ACOSOG Z9001 indicate that adjuvant imatinib for 1 year prolongs recurrence-free survival following surgical resection of larger (at least 3 cm) KIT-expressing GIST. Other ongoing studies are further exploring the role of imatinib in both adjuvant and neoadjuvant therapy. Recent updates to clinical practice guidelines and recommendations now incorporate some of these new findings.