消化管GISTの治療―外科的治療

Surgical Treatment of GIST

要旨　当科のGIST症例37例，43病変を分析した．当科治療の初発GISTの部位は胃（66％）が最も多く，十二指腸（14％）が続いた．外科治療は主に局所切除が行われた．NCCNのリスク分類Highに相当する病変では，11例中10例で転移・再発がみられた．転移・再発GIST症例の予後は3年生存率29％と不良であったが，外科治療が行われた症例では3年生存率100％と予後良好であった．初発GIST治療では手術が行われ，転移・再発例においてはimatinibが加わる．両者を組み合わせた治療体系の確立が今後の課題である．

　Thirty-seven cases, 43 lesions of GISTs in our department were analyzed. Gastric GISTs were in the majiority and duodenal ones were the second most frequent. Local excision was the procedure mainly performed in the surgical treatment of GISTs.

　Ten of 11 cases which corresponded to the ‘high risk' degree in the classification of NCCN (National Comprehensive Cancer Network) were metastatic or recurrent cases. The prognosis of metastatic or recurrent cases of GISTs was very poor and a 3-year survival rate without treatment was only 29％, but the survival rate of those treated by surgery was good with 100％ achieving 3-year survival. In first cases of GIST, surgery is the main treatment, but in metastatic or recurrent cases imatinib and/or surgery are chosen. The development of a system of treatment including surgery and imatinib for metastatic or recurrent GISTs is a desirable goal.