胃肠间质瘤患者甲磺酸伊马替尼常规治疗失败后的生存状况及其后续处理

Patients with gastrointestinal stromal tumors with imatinib mesylate after failure of conventional treatment and follow-up treatment the living conditions

目的探讨甲磺酸伊马替尼加量、换用苹果酸舒尼替尼、对症处理3种后续治疗对胃肠间质瘤（GIST）术后常规剂量甲磺酸伊马替尼治疗失败患者临床症状和生存时间的影响。方法术后常规剂量甲磺酸伊马替尼治疗失败的GIST患者40例,随机分为甲磺酸伊马替尼加量（14例）、换用苹果酸舒尼替尼（14例）、对症处理（12例）3种后续治疗组,并对患者后续治疗后情况进行随访。比较3种后续治疗的临床疗效和生存状况等。结果 3种后续治疗的疗效差异有统计学意义（P〈0.01）,苹果酸舒尼替尼组的有效率（28.6%）和临床获益率（92.9%）明显高于其他两组。随访1年以上者36例,1、2年生存率分别为67.5%、47.3%。多因素分析结果显示,性别、后续治疗前KPS评分、初治转移部位及初治后病灶密度是否降低是独立预后因素。甲磺酸伊马替尼加量组和苹果酸舒尼替尼组发生3~4级毒性反应发生率分别22.5%、42.5%。结论换用苹果酸舒尼替尼的获益率较高,性别、后续治疗前KPS评分、初治转移部位及初治病灶密度是否降低可以作为判断GIST临床预后的参考治疗。

Objective To investigate effects of imatinib mesylate dose incresement,switching to sunitinib malate and symptomatic treatment on clinical symptoms and survival time of gastrointestinal stromal tumors（GIST）after conventional-dose imatinib mesylate in patients with treatment failure.Methods 40 cases conventional dose imatinib mesylate in GIST treatment failure were randomly divided into imatinib mesylate dose incresement（14 cases）,switching to sunitinib malate（14 cases）,symptomatic treatment（12 cases）of three follow-up treatment group,and patients were followed up.Comparison of the clinical efficacy of subsequent treatment and survival status.Results The efficacy of three follow-up treatment significantly,sunitinib malate group rate（28.6%）and clinical benefit rate（92.9%） was significantly higher than the other groups;36 cases were followed up for more than 1 year.1 year,2 year survival rates were 67.5%,47.3%.Multivariate analysis showed that gender,follow-up KPS score before treatment,initial treatment after the initial treatment of metastatic sites and whether the lower density of lesions was an independent prognostic factor.That dominican amount of imatinib group and sunitinib group had grade 3 to 4 toxicity rates were 22.5%,42.5%.Conclusion Sunitinib for the benefit of using higher rate.Gender,follow-up KPS score before treatment,initial treatment in newly diagnosed metastatic sites and whether the lower density of lesions as judged prognosis of gastrointestinal stromal tumors of the reference treatment.