摘要
胃肠间质瘤(GIST)是胃肠道最常见的间叶来源肿瘤,当前国内外已有多个专业学术团体及行业学会针对GIST的诊断治疗推出了相应的诊疗指南。2020年,中国临床肿瘤学会(CSCO)胃肠间质瘤专家委员会发布了我国首部《CSCO胃肠间质瘤诊疗指南》;美国国家综合癌症网络(NCCN)也在同年首次把GIST相关内容从《软组织肉瘤指南》中独立出来,发布了首部NCCN《胃肠间质瘤诊疗实践指南》(2021年第1版)。但是从国内临床实践来看,在不少环节上存在指南推荐意见与临床实际操作不一致的情况,如在诊断方面,存在分子检测重视程度及普及程度参差不齐、分子检测报告格式并不统一规范、检测手段选择不合理、野生型GIST诊断不规范、危险度评估不合理以及内镜超声引导下细针穿刺活检(EUS⁃FNA)应用率低等问题;在药物治疗方面,存在靶向药物剂量和疗程不规范以及超适应证用药(如跨线治疗)等情况;在手术治疗方面,存在腹腔镜手术临床应用场景超过指南推荐范围以及指南对于晚期GIST外科介入相关的笼统表述不能很好地指导具体的临床工作等问题。在此背景下,临床医师一方面,需要了解学术前沿进展,以最新的指南来规范自身的医疗行为;另一方面,需要在部分指南尚未明晰的临床问题上,兼顾疗法的科学性和可及性,以患者是否能够最大程度获益为指导标准。
Gastrointestinal stromal tumor(GIST)is the most common mesenchymal tumor in the gastrointestinal tract.At present,many professional academic groups and associations at home and abroad have released guidelines for the diagnosis and treatment of GIST.In 2020,Gastrointestinal Stromal Tumor Expert Committee of China Society of Clinical Oncology(CSCO)issued the first"CSCO gastrointestinal stromal tumor diagnosis and treatment guidelines"in China.In the same year,NCCN also released the first"NCCN guideline for the diagnosis and treatment of gastrointestinal stromal tumors(first edition in 2021)"by separating GIST⁃related content from the guideline for soft tissue sarcoma.However,there are many inconsistencies between the guidelines'recommendation and clinical practice in China.For example,in the aspect of diagnosis,the emphasis on and implementation of molecular detection are variable,the format of molecular detection report is not unified or standardized,the selection of detection methods is inappropriate,the diagnosis of wild⁃type GIST is not standardized,the risk assessment is improper,and the use of EUS⁃FNA is relatively seldom;in the aspect of drug therapy,there are some problems,such as the lack of standardization in dose and course of targeted drugs,and off⁃label medication such as cross line therapy;in terms of surgical treatment,there are also some problems,such as the clinical application scenarios of laparoscopic surgery exceed the recommendations of the guidelines,and the general description of surgical intervention of advanced GIST in the guidelines cannot well guide specific clinical practice.In this context,on the one hand,clinicians need to understand the academic frontier and standardize their medical behavior with the latest guidelines;on the other hand,clinicians need to consider the scientific rationale and accessibility of treatment on some clinical problems that are not clear in the guidelines,and take whether patients can benefit the most as the criteria.
作者
曹晖
汪明
Cao Hui;Wang Ming(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2021年第9期749-757,共9页
Chinese Journal of Gastrointestinal Surgery
基金
2017年上海市领军人才项目
国家自然科学基金面上项目(82072669)
国家自然科学基金青年项目(81702303)。
关键词
胃肠间质瘤
诊疗指南
临床实践
Gastrointestinal stromal tumor
Practice guidelines
Clinical practice
