对极高危胃肠间质瘤的认识

Preliminary understanding of gastrointestinal stromal tumor with the highest risk

目前，手术切除仍是胃肠间质瘤（GIST）的首选治疗方法。然而，即使肿瘤凡切除后仍有相当一部分患者会出现肿瘤的复发转移：虽然伊马替尼等靶向药物的临床应用使GIST患者的预后得以明显改善，但部分高危患者仍在辅助治疗的疗程结束后发生肿瘤复发转移。由此可以看出，目前用于指导GIST患者进行辅助治疗的2008改良NIH分级标准存在一定不足，它尚不能预测GIST患者的术后复发概率．并不能达到个体化治疗的目的，特别对一些高核分裂象数的患者，可能存在治疗疗程不足等缺点。因此，国内外的学者开始认识到，在高危患者中，部分高核分裂数GIST具有高度恶性生物学行为，极易发生复发转移，并将其称为极高危GIST，其分级标准及治疗疗程目前仍在进一步探索中。

Nowadays, surgery still remains the mainstay treatment for gastrointestinal stromal tumor （GIST）. Nevertheless, some GIST patients have also experienced tumor recurrence/metastasis even with R0 resection. Meanwhile, the prognosis of GIST has been dramatically improved after targeted drug imatinib used in clinical practice for GIST, but tumor recurrence/metastasis still occurred in some patients with high-risk when adjuvant treatment course ended, as such, the 2008 modified NIH criterion, which is used to guide the adjuvant treatment of GIST, still has shortcomings. This criterion can not accurately predict the postoperative recurrence probability and also fails to achieve the purpose of individualized treatment, especially for those patients with high mitotic index who may experience insufficient treatment. Therefore, some domestic and foreign scholars realize that some high-risk GIST lesions with high mitotic index exhibit higher malignant biological behavior, namely highest risk GIST, which is easier to present tumor recurrence/metastasis. The appropriate classification criteria and treatment course are still needed to further exploration.