NCCN《软组织肉瘤临床实践指南(2017年第2版)》胃肠间质瘤内容介绍与更新解读

Updates and interpretations of the NCCN Clinical Practice Guidelines(2017 second version) on gastrointestinal stromal tumor

胃肠间质瘤(gastrointestinal stromal tumor,GIST)的诊断和治疗已日趋标准化和规范化。近10余年来,随着分子水平发病机制的揭示和小分子酪氨酸激酶受体抑制剂的成功应用,GIST已经成为精准医疗时代最经典的实体肿瘤靶向治疗成功范例之一。2017年2月,美国国家综合癌症网络(NCCN)发布了最新版的《软组织肉瘤临床实践指南(2017年第2版)》,与既往版本相比,新版指南中GIST部分内容主要更新了GIST的影像学评估及恶性潜能评估方面的内容,并在讨论章节中,根据新的循证医学证据,提出了基因分型与GIST病人预后的相关性,突出了腹腔镜手术在GIST治疗中的地位。

The diagnosis and treatment of gastrointestinal stromal tumor （GIST） is getting more and more standardized. In the last decade,due to the revelation of the molecular mechanism of its tumorigenesis,as well as the effectiveness of tyrosine kinase inhibitors,GIST has become well known as one of the most classical models of targeted therapy on solid tumor in the precision medicine era. The National Comprehensive Cancer Network （NCCN） issued the latest version of clinical practice guideline on GIST in Feb. 2017. The updated guideline standardized the principle of imaging and updated the predictor of GIST biological behavior. Given the newly emerged evidence from clinical trials,in the discussion chapter,the updated guideline also highlighted the prognostic value of mutational characteristics and the role of laparoscopic surgery in the treatment of GIST. The paper provides interpretations of the updates,aiming to improve the clinical practice of GIST.