胃肠间质瘤危险度分级的前世与今生及其临床指导价值

Past and present of risk stratification of gastrointestinal stromal tumors and its clinical value

胃肠间质瘤(GIST)是胃肠道最常见的软组织肉瘤,它的生物学行为多种多样。制定准确的危险度分级、评估原发肿瘤切除术后的复发转移危险、指导辅助治疗以及预测患者预后,具有重要的临床意义。GIST危险度分级标准自面世以来,随着对GIST疾病逐渐深入地了解,不断地经历了变革和完善。初期主要是根据肿瘤大小、核分裂象计数等临床参数制定危险度分级;中期再把肿瘤部位、肿瘤破裂等因素纳入而形成较为完善的美军病理研究所(AFIP)标准以及改良美国国立卫生研究院(NIH)分级;近期更有研究使用新的统计学方法如列线图、等高线图等,使得预测患者复发风险更为精准,由此让GIST个体化治疗变成可能。

Gastrointestinal stromal tumor(GIST)is the most common soft tissue sarcoma in the gastrointestinal tract.Biological behavior of GIST is varied.It is very important to accurately assess the risk of recurrence and metastasis after resection of primary tumor in order to guide adjuvant therapy and predict prognosis.With increasing understanding of the biological behavior of GIST,the risk stratification criterion has undergone continuous reform and improvement since its introduction.In the early stage,clinical parameters such as tumor size and mitotic rate were formulated as risk stages,and then tumor site,tumor rupture and other factors were included to form a more accurate AFIP standard and modified NIH risk stratification.Recently,more researches have used new statistical methods such as nomogram and contour maps,which more accurately predict risk of recurrence and better guide adjuvant treatment.Thus,individualized treatment of GIST becomes possible.