胃肠间质瘤若干热点问题及其进展

Gastrointestinal Stromal Tumours:Hot Issues and Recent Advances

近年来,胃肠间质瘤(GIST)在活检时机选择、分子标志物、基因突变分析、预后因素(肿瘤危险分级)、靶向治疗效果评估方法、腹腔镜手术进展、进展期患者术前药物治疗及手术时机选择、靶向治疗耐药机制及应对策略等热点问题达成诸多共识。活检、分子标志物、基因突变分析对GIST早期诊断及指导治疗具有重要意义。进展期患者应早期行术前评估,并且进行危险分级,对手术风险较大患者可先进行术前治疗,并早期进行疗效评价,对于肿瘤降级后可行手术切除者尽早手术切除,而对于靶向治疗无反应的患者,应尽早行基因分析,并根据不同耐药机制采取不同应对策略。

Consensus on the diagnosis and treatment of gastrointestinal stromal tumours（GISTs） has been achieved with the multi-disciplinary research recently,including biopsy timing,molecular markers,gene mutation analysis,prognostic factors（risk stratification systems）,targeted treatment effect assessment,laparoscopic surgery progress,preoperative medication and timing of surgery in advanced GISTs,resistance mechanism and response strategy of targeted therapy.Biopsy,molecular markers,and gene mutation analysis of GIST are of great significance for early diagnosis and treatment.Early preoperative evaluation and risk classification should be performed in advanced GISTs.Preoperative treatment can be carried out in patients with high risk of operation,followed by feasible excision as soon as possible after the reduction of tumor grade.However,if the patient is unresponsive to the targeted therapy,gene analysis should be performed as soon as possible,followed by different theraputic strategies based on different mechanisms of drug resistance.