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Current clinical management of gastrointestinal stromal tumor

World Journal of Gastroenterology 2018年第26期24卷 2806-2817页

作者： Kazuya Akahoshi Masafumi Oya tadashi koga Yuki Shiratsuchi Department of Gastroenterology Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Department of Surgery Aso Iizuka Hospital

Gastrointestinal stromal tumors(GISTs) are the most common malignant subepithelial lesions(SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1(DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography(EUS) and EUS-guided fine needle aspiration(EUSFNA) are critical for an accurate diagnosis of SELs. EUSFNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

关键词： Gastrointestinal stromal tumor Endoscopic ultrasonography-guided fine needle aspiration Endoscopic ultrasonography Diagnosis Therapy

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Efficacy and safety of sofosbuvir and ledipasvir in Japanese patients aged 75 years or over with hepatitis C genotype 1

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World Journal of Hepatology 2017年第36期9卷 1340-1345页

作者： Yoshinori Ozono Kenji Nagata Satoru Hasuike Hisayoshi Iwakiri Kenichi Nakamura Mai Tsuchimochi Yuri Yamada Yuka Takaishi Mitsue Sueta tadashi Miike Yoshihiro Tahara Shojiro Yamamoto Kotaro Shide Tomonori Hidaka Yoko Kubuki Kazunori Kusumoto Toshimasa Ochiai Junya Kato Naoto Komada Shuichi Hirono Kazuo Kuroki Masafumi Shigehira Kazuya Shimoda Department of Gastoroenterology and Hematology Faculty of Medicine University of Miyazaki Department of Liver Disease University of Miyazaki Hospital Department of Internal Medicine Koga General Hospital Department of Internal Medicine National Hospital Organization Miyakonojo Medical Center Department of Internal Medicine Hirono Naika Clinic Department of Internal Medicine Kushima Municipal Hospital Department of Internal Medicine Shigehira Clinic

AIM To evaluate the efficacy and safety of a regimen containing sofosbuvir(SOF) and ledipasvir(LDV) in Japanese patients aged ≥ 75 years with hepatitis C genotype *** This multicenter, retrospective study consisted of 246 Japanese patients with HCV genotype 1 at nine centers in Miyazaki prefecture in Japan. Demographic, clinical, virological, and adverse effects(AE)-related data obtained during and after SOF/LDV therapy were collected from medical records. These patients were divided into two groups, younger(aged < 75 years) and elderly(aged ≥ 75 years). Virological data and AEs were analyzed by age *** The sustained virological response(SVR) rates at 12 wk after treatment were 99.2%, 99.4%, and 98.7% in the overall population and in patients aged < 75 and ≥ 75 years, respectively. Common AEs during therapy were headache, pruritus, constipation, and insomnia. These occurred in fewer than 10% of patients, and their incidence was not significantly different between the younger and elderly groups. Two patients discontinued treatment, one due to a skin eruption and the other due to cerebral bleeding. CONCLUSION Compared with younger patients, elderly patients had a similar virological response and tolerance to SOF/LDV therapy.

关键词： Chronic hepatitis C Sofosbuvir Ledipasvir Sustained virological response Direct acting antivirals

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