Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGXian-jin ¹ , CHENJia-hui ² , DUJiang ^1,3 ,  WANGChong-shu ^1,3

1. The First Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2. Department of Gastrointestinal Surgery, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
3. Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding?author：

WANGChong-shu, Email: chongs-wang@163.com

Keywords：

Gastrointestinal stromal tumor; Diagnosis; Treatment; C-kit gene; Platelet-derived growth factor receptor alpha

DOI：

10.7507/1007-9424.20140250

Video：

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Objective To summarize the pathogenesis and epidemiology features of gastrointestinal stromal tumor(GIST), explore its diagnosis and therapy, and analyze its prognosis. Method The pertinent literatures about the pathogenesis, epidemiology features, diagnosis, therapy, and prognosis of GIST in recent years were reviewed. Results GIST was non-epithelial tumor which derived from interstitial cells of Cajal, was the most common mesenchymal tumor about accounting for 1%-3% in the digestive tract tumor. The median onset age of patients with GIST was 40-60 years. The gastric stromal tumor was about 60% in all the digestive tract tumor. The current consensus statement was that there was a relation between the pathogenesis of the GIST and proto-oncogene c-kit or platelet-derived growth factor receptor alpha(PDGFRα)gene mutation. But the mutations of PDGFRαand c-kit gene did not emerge at the same time in the same patient. The clinical manifestations of GIST were not specific, and the diagnosis mainly depended on endoscope and image technology, the correct diagnosis depended on pathological examination. The treatment of GIST was given priority of surgery and molecular targeted drug therapy, and the prognosis was closely related to risk assessment stratify of GIST. Conclusions GISTs are mesenchymal tumors that has a potential of malignant transformation, the risk classification criteria for aggressive clinical course of primary GIST is an important indication for guiding the clinical therapy and prognostic evaluation. Further research would be needed in prevention, diagnosis, treatment, and relapse prevention of GIST.

Citation： YANGXian-jin, CHENJia-hui, DUJiang, WANGChong-shu. Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1040-1045. doi: 10.7507/1007-9424.20140250 Copy

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8.	Heinrich MC, Rubin BP, Longley BJ, et al. Biology and genetic aspects of gastrointestinal stromal tumors:KIT activation and cytogenetic alterations[J]. Hum Pathol, 2002, 33(5):484-495.
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1. Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis[J]. Am J Surg Pathol, 1983, 7(6):507-519.
2. CSCO胃腸間質瘤專家委員會.中國胃腸間質瘤診斷治療專家共識(2011年版)[J].臨床腫瘤學雜志, 2011, 16(9):836-844.
3. Lux ML, Rubin BP, Biase TL, et al. KIT extracellular and kinase domain mutations in gastrointestinal stromal tumors[J]. Am J Pathol, 2000, 156(3):791-795.
4. Doyle LA, Hornick JL. Gastrointestinal stromal tumours:from KIT to succinate dehydrogenase[J]. Histopathology, 2014, 64(1):53-67.
5. Beadling C, Patterson J, Justusson E, et al. Gene expression of the IGF pathway family distinguishes subsets of gastrointestinal stromal tumors wild type for KIT and PDGFRA[J]. Cancer Med, 2013, 2(1):21-31.
6. 王彥麗, 趙向榮, 白辰光, 等.胃腸道間質瘤組織中PDGFRα和C-kit基因突變和蛋白表達的關系[J].世界華人消化雜志, 2007, 15(21):2300-2305.
7. Miettinen M, Monihan JM, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery:clinicopathologic and immunohistochemical study of 26 cases[J]. Am J Surg Pathol, 1999, 23(9): 1109-1118.
8. Heinrich MC, Rubin BP, Longley BJ, et al. Biology and genetic aspects of gastrointestinal stromal tumors:KIT activation and cytogenetic alterations[J]. Hum Pathol, 2002, 33(5):484-495.
9. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors presenting as omental masses-A clinicopathologic analysis of 95 cases[J]. Am J Surg Pathol, 2009, 33(9):1267-1275.
10. Miettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejunum and ileum-A clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up[J]. Am J Surg Pathol, 2006, 30(4):477-489.
11. Corless CL, Schroeder A, Griffith D, et al. PDGFRA mutations in gastrointestinal stromal tumors:frequency, spectrum and in vitro sensitivity to imatinib[J]. J Clin Oncol, 2005, 23(23): 5357-5364.
12. Lamba G, Gupta R, Lee B, et al. Current management and prognostic features for gastrointestinal stromal tumor (GIST)[J]. Exp Hematol Oncol, 2012, 1(1):14.
13. Beham AW, Schaefer IM, Schüler P, et al. Gastrointestinal stromal tumors[J]. Int J Colorectal Dis, 2012, 27(6):689-700.
14. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach-A clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1):52-68.
15. 張啟瑜.錢禮腹部外科學[M].北京:人民衛生出版社, 2006: 230-231.
16. 楊弘鑫, 陳秀峰, 張波, 等. 217例胃間質瘤的臨床特點與診治[J].中國普外基礎與臨床雜志, 2012, 19(9):951-956.
17. 胡月穎.胃腸道間質瘤的影像學診斷[J].醫學理論與實踐, 2013, 26(11):1440-1442.
18. 宗春華, 徐雷鳴, 陳惠芳.內鏡超聲檢查術在胃間質瘤中的診斷價值[J].中國內鏡雜志, 2006, 12(9):917-918, 921.
19. 李建衛, 吳松松, 朱琳, 等.彩色多普勒超聲鑒別診斷胃間質瘤與胃癌[J].中國醫學影像技術, 2011, 27(6):1227-1230.
20. 鄭育聰, 李健丁, 張瑞平.胃腸道間質瘤的影像學研究進展[J].世界華人消化雜志, 2010, 18(1):49-53.
21. 李成明, 張瑜, 祝青松, 等. CT診斷胃間質瘤[J].中國醫學影像學雜志, 2008, 16(2):145-146.
22. 易亞輝, 周建勝.胃間質瘤的CT和MRI診斷[J].中國醫學影像學雜志, 2006, 14(5):336-340.
23. Levy AD, Remotti HE, Thompson WM, et al. Gastrointestinal stromal tumors:radiologic features with pathologic correlation[J]. Radiographics, 2003, 23(2):283-304, 456.
24. 劉長青, 譚詩云, 李軍華, 等.超聲內鏡聯合CT對胃間質瘤的臨床診斷價值[J].世界華人消化雜志, 2012, 20(25):2404-2406.
25. 王鈞. 32例胃腸道間質瘤的病理學及免疫組化研究[J].當代醫學, 2012, 18(12):4-5.
26. 哈英娣, 李青清, 蘇勤軍, 等.胃間質瘤的臨床病理改變[J].現代腫瘤醫學, 2008, 16(8):1346-1348.
27. 戎龍, 萬遠廉, 年衛東, 等.胃間質瘤63例臨床分析[J].中華胃腸外科雜志, 2009, 12(1):24-27.
28. Espinosa I, Lee CH, Kim MK, et al. A novel monoclonal antibody against DOG1 is a sensitive and specific marker for gastrointestinal stromal tumors[J]. Am J Surg Pathol, 2008, 32(2): 210-218.
29. 王卓才, 賴日權, 黃小讓, 等.胃間質瘤CD34, SMA, S-100蛋白表達與細胞增殖和預后關系[J].廣東醫學, 2002, 23(8): 823-824.
30. Tsujimura T, Makiishi-Shimobayashi C, Lundkvist J, et al. Expression of the intermediate filament nestin in gastrointestinal stromal tumors and interstitial cells of Cajal[J]. Am J Pathol, 2001, 158(3):817-823.
31. Kang KY, Lee W. Gastrointestinal stromal tumor with extensive lymphatic metastasis:a case report[J]. J Gastric Cancer, 2013, 13(3):192-195.
32. 何裕隆.胃腸間質瘤臨床病例解析[J].國際外科學雜志, 2007, 34(5):354-358.
33. Dematteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour:a randomised, double-blind, placebocontrolled trial[J]. Lancet, 2009, 373(9669):1097-1104.
34. 熊炳賢, 李紅浪, 曾飛, 等.胃間質細胞瘤18例診治分析[J].中國普通外科雜志, 2004, 13(9):670-672.
35. 柴宇嘯, 曲興龍, 李雷, 等.胃間質瘤16例診治分析[J].中國普通外科雜志, 2009, 18(10):1091-1093.
36. 師英強, 杜春燕, 周燁, 等.胃腸間質瘤聯合臟器切除22例療效分析[J].中國實用外科雜志, 2008, 28(4):273-274.
37. 魏志剛, 韓超, 李健丁.胃腸道間質瘤的診斷治療[J].世界華人消化雜志, 2010, 18(1):65-69.
38. Winfield RD, Hochwald SN, Vogel SB, et al. Presentation and management of gastrointestinal stromal tumors of the duodenum[J]. Am Surg, 2006, 72(8):719-723.
39. 陳凜, 李濤.十二指腸間質瘤臨床診斷與治療[J].中國實用外科雜志, 2008, 28(11):945-946.
40. 何裕隆.胃腸間質瘤外科治療的選擇[J].中華胃腸外科雜志, 2006, 9(1):15-16.
41. 師英強, 杜春燕.胃腸間質瘤的外科治療問題[J].腫瘤研究與臨床, 2006, 18(8):518-520.
42. 張旭, 戎鐵華, 吳秋良, 等.食管間質瘤與平滑肌腫瘤的臨床鑒別及治療[J].癌癥, 2006, 25(7):901-905.
43. Hornick LJ, Fletcher CD. The role of KIT in the management of patients with gastrointestinal stromal tumors[J]. Hum Pathol, 2007, 38(5):679-687.
44. 張文, 陳治宇, 王磊蘋, 等.伊馬替尼治療晚期胃腸道間質瘤[J].中國癌癥雜志, 2008, 18(1):42-45.
45. Zalcberg JR, Verweij J, Casali PG, et al. Outcome of patients with advanced gastrointestinal stromal tumours crossing over to a daily imatinib dose of 800 mg after progression on 400 mg[J]. Eur J Cancer, 2005, 41(12):1751-1757.
46. 周辛欣, 季峰.胃腸道間質瘤分子靶向治療研究進展[J].國際消化病雜志, 2009, 29(5):346-348.
47. 王春萌, 師英強, 傅紅, 等.甲磺酸伊馬替尼治療胃腸道間質瘤的療效及安全性分析[J].中國癌癥雜志, 2008, 18(11): 873-875.
48. Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib:a randomised controlled trial[J]. Lancet, 2006, 368(9544):1329-1338.
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Present Situation and Progress of Diagnosis and Treatment of Gastrointestinal Stromal Tumor

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