medigraphic.com

2012, Número 1

<< Anterior Siguiente >>

Cir Cir 2012; 80 (1)


Tumores estromales gastrointestinales: diagnóstico y tratamiento

Acín-Gándara D, Pereira-Pérez F, Ángel Castaño-Pascual Á, Durán-Poveda M, Antequera-Pérez A, Miliani-Molina C

Idioma: Español
Referencias bibliográficas: 39
Paginas: 44-51
Archivo PDF: 394.13 Kb.


RESUMEN

Introducción: los tumores de la estroma gastrointestinal (GIST) son las neoplasias mesenquimales del tracto digestivo más frecuentes. Originados de las células intersticiales de Cajal se caracterizan por la sobreexpresión de la proteína KIT (tirosincinasa). El pronóstico de los GIST avanzados ha mejorado con el descubrimiento del mesilato de imatinib.
Material y métodos: estudio retrospectivo, descriptivo de los GIST diagnosticados en nuestro centro en los últimos 5 años. Se excluyeron aquellos pacientes diagnosticados incidentalmente en el contexto de otra enfermedad. Las variables estudiadas fueron: clínica, localización, tamaño, pruebas de imagen, resecabilidad, neoadyuvancia con imatinib, técnica quirúrgica, histología, inmunohistoquímica, clasificación pronóstica de Fletcher, morbilidad y mortalidad, seguimiento, supervivencia general y libre de enfermedad.
Resultados: se diagnosticaron 19 pacientes (14 varones y 5 mujeres) con edad media de 63 años (rango: 30-84). El diagnóstico fue incidental en 8 pacientes (42%). La localización tumoral de los 11 restantes (58%) fue: 6 intestino delgado (55%), 4 gástricos (36%) y 1 rectal (9%). Predominó la anemia y fueron diagnosticados mayoritariamente por tomografía computada (TC) abdominal. Al diagnóstico 9 pacientes se consideraron resecables (82%) y otros 2 (18%) recibieron tratamiento neoadyuvante. Se trataron 3 pacientes con imatinib posoperatorio (33%). La mediana de supervivencia fue 34 meses (rango: 5-58).
Conclusiones: el diagnóstico de GIST con frecuencia es incidental. La clínica predominante suele ser la anemia y la prueba de imagen la TC. El tratamiento de elección es quirúrgico, salvo el GIST avanzado que habitualmente recibe tratamiento neoadyuvante con mesilato de imatinib. Es fundamental realizar un abordaje multidisciplinario, lo que condiciona el pronóstico y la supervivencia de estos pacientes.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Nishida T, Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol 2000;15:1293-1301.

  2. Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumor. Lancet 2007;369:1731-1741.

  3. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 2007;5(suppl 2):S1-29.

  4. Thomas RM, Sobin LH. Gastrointestinal cancer. Cancer 1995;75(suppl 1):154-170.

  5. Nishida T, Takahashi T, Miyazaki Y. Gastrointestinal stromal tumor: a bridge between bench and bedside. Gastric Cancer 2009;12:175-188.

  6. Robinson TL, Sircar K, Hewlett BR, Chorneyko K, Riddell RH, Huizinga JD. Gastrointestinal stromal tumors may originate from a subset of CD34-positive insterstitial cells of Cajal. Am J Pathol 2000;156:1157-1163.

  7. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259-1269.

  8. Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol 2004;22:3813-3825.

  9. Tornillo L, Terracciano LM. An update on molecular genetics of gastrointestinal stromal tumours. J Clin Pathol 2006;59:557-563.

  10. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-fuction mutations of c-kit in human gastrointestinal stromal tumors. Science 1998;279:577-580.

  11. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-465.

  12. Cormier JN, Patel SR, Pisters PW. Gastrointestinal stromal tumours: rationale for surgical adjuvant trials with imatinib. Curr Oncol Reports 2002;4:504-509.

  13. Demetri GD. Identification and treatment of chemoresistant inoperable or metastatic GIST: experience with a selective tyrosine kinase inhibitor imatinib mesylate. Eur J Cancer 2002;38:S52-59.

  14. Sanchez-Hidalgo JM, Muñoz-Casares FC, Rufian-Peña S, Naranjo- Torres A, Ciria-Bru R, Briceño-Delgado J, et al. Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction. Rev Esp Enferm Dig 2007;99:703-708.

  15. Martin-Lorenzo JG, Aguayo-Albasini JL, Torralba-Martinez JA, Liron-Ruiz R, Gimenez-Bascuñana A, Miquel-Perello J, et al. Gastrointestinal stromal tumors. Diagnosis, prognosis and current surgical treatment. Follow-up of 18 treated patients. Cir Esp 2006;79:22-27.

  16. Eizaguirre-Zarza B, Burgos-Bretones J. GIST tumors. A literature review. Rev Esp Patol 2006;39:209-218.

  17. Nowain A, Bhakta H, Pais S, Kanel G, Verma S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 2005;20:818-824.

  18. Ha CY, Shan R, Chen J, Azar RR, Edmundowicz SA, Early DS. Diagnosis and management of GI stromal tumors by EUS-FNA: a survey of opinions and practices of endosonographers. Gastrointest Endosc 2009;69:1039-1044.

  19. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566-578.

  20. Corless CL, Schroeder A, Griffith D, Town A, McGreevey L, Harrell P, et al. PDGFRA mutations in gastrointestinal stromal tumors: frequency, spectrum and in vitro sensitivity to imatinib. J Clin Oncol 2005;23:5357-5364.

  21. Antoch G, Kanja J, Bauer S, Kuehl H, Renzing-Koehler K, Schuette J, et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 2004;45:357-365.

  22. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216.

  23. Padhani AR, Ollivier L. The RECIST criteria: implications for diagnostic radiologists. Br J Radiol 2001;74:983-986.

  24. Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 2007;25:1753-1759.

  25. Singer S, Rubin B, Lux M, Chen CJ, Demetri GD, Fletcher CD, et al. Prognostic value of KIT mutation type, mitotic activity, and histologic subtype in gastrointestinal stromal tumors. J Clin Oncol 2002;20:3898-3905.

  26. Huang HY, Huang WW, Lin CN, Eng HL, Li SH, Li CF, et al. Immunohistochemical expression of p16INK4A, Ki-67, and Mcm2 proteins in gastrointestinal stromal tumors: prognostic implications and correlations with risk stratification of NIH consensus criteria. Ann Surg Oncol 2006;13:1633-1644.

  27. Nemoto Y, Mikami T, Hana K, Kikuchi S, Kobayashi N, Watanabe M, et al. Correlation of enhanced cell turnover with prognosis of gastrointestinal stromal tumors of the stomach: relevance of cellularity and p27kip1. Pathol Int 2006;56:724-731.

  28. Schmieder M, Wolf S, Danner B, Stoehr S, Juchems MS, Wuerl P, et al. p16 expression differentiates high-risk gastrointestinal stromal tumor and predicts poor outcome. Neoplasia 2008;10:1154-1162.

  29. Kang YN, Jung HR, Hwang I. Clinicopathological and immunohistochemical features of gastrointestinal stromal tumors. Cancer Res Treat 2010;42:135-143.

  30. Fernández JA, Sánchez-Cánovas ME, Parrilla P. Controversies in the surgical treatment of primary gastrointestinal stromal tumours (GIST). Cir Esp 2010;88:69-80.

  31. Joensuu H. Tyrosine kinase inhibitor as a target therapy for GIST tumors. Duodecim 2002;118:2305-2312.

  32. Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg 2009;96:567-578.

  33. Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 2005;103:821-829.

  34. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-58.

  35. Tabrizian P, Nguyen SQ, Divino CM. Laparoscopic management and long-term outcomes of gastrointestinal stromal tumors. J Am Coll Surg 2009;208:80-86.

  36. Rutkowski P, Nowecki ZI, Michej W, Debiec-Rychter M, Woźniak A, Limon J, et al. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor. Ann Surg Oncol 2007;14:2018-2027.

  37. Artigas-Raventós V, López-Pousa A. Tumores de la estroma gastrointestinal: nuevos conceptos y estrategias terapéuticas multidisciplinares médico-quirúrgicas. Cir Esp 2006;79:1-2.

  38. Fernández JA, Parrilla P. Surgical treatment of an advanced GIST: the age of imatinib. Cir Esp 2009;86:3-12.

  39. Deshaies I, Cherenfant J, Gusani NJ, Jiang Y, Harvey HA, Kimchi ET, et al. Gastrointestinal stromal tumor (GIST) recurrence following surgery: review of the clinical utility of imatinib treatment. Ther Clin Risk Manag 2010;6:453-458.




2020     |     www.medigraphic.com