智者见于未萌——论胃肠间质瘤诊断和治疗决策中应努力规避的陷阱和困境

Pitfalls and dilemmas in the decision-making process of diagnosis and treatment on gastrointestinal stromal tumor

胃肠间质瘤(GIST)是胃肠道最常见的间叶源性肿瘤,分子靶向药物的成功应用推动了GIST的临床诊疗进入了精准医学时代。GIST的诊断(包括术前诊断和病理诊断)、外科治疗(包括外科手术、微创治疗、复发转移性GIST的外科手术)和药物治疗(包括极高危GIST辅助治疗时限、术前治疗的干预时机)环环相扣,各个环节都存在一定的陷阱和误区,一旦误入,除了给医者带来困境,更可致医疗资源浪费,甚至危及患者的健康乃至生命。每位从事GIST诊疗的医师需要充分认识GIST的生物学特性和疾病发展规律,在诊疗工作中准确识别每一个可能的陷阱。本文从GIST诊疗的各个环节浅析可能存在的陷阱和误区,以期为推进更合理的临床决策提供参考。

Gastrointestinal stromal tumor(GIST)is the most common mesenchymal tumor in the gastrointestinal tract.The successful application of molecular targeted agents has promoted the clinical diagnosis and treatment of GIST into the era of precision medicine.There are some pitfalls in the diagnosis(including preoperative diagnosis and pathological diagnosis),surgical treatment(including surgical procedure,minimally invasive surgery,and surgery for recurrent/metastatic GIST)and drug treatment(including duration of adjuvant therapy for very high risk GIST and timing of intervention during preoperative treatment)of GIST.In addition to difficulties of doctors,these pitfalls can also lead to waste of medical resources,and even endanger the health and life of patients.Each doctor engaged in the diagnosis and treatment of GIST needs to fully understand the biological characteristics and disease development pattern of GIST,and accurately recognize every possible trap in the clinical management.This paper analyzes the pitfalls and misunderstandings in various aspects of GIST diagnosis and treatment in order to provide clues for promoting more reasonable clinical decision-making.