胃肠道间质瘤诊治指南解读

·8·201541ChinJColorecDisElectronicEdition2015Vol．4No．1··、、。、、－、。、、、。、、、、、、、、、、CSCO、、、、、、。、、、、、。。《》《》、《》。100、。【】gastrointestinalstromaltumorsGISTs。。。2014NationalComprehensiveCancerNetworkNCCN2014EuropeanSocietyofMedicalOncologyESMO、、、、。。【】InterpretationofguidelineformanagementofgastrointestinalstromaltumourYULei*LIANGXiao-bo．*DepartmentofColorectalCancerSurgeryTheSecondAffiliatedHospitalTheColorectalCancerInstituteHarbinMedicalUniversityH[e-mail]【Abstract】AstheraretumoringastrointestinalGItracttheincidenceofGISTsisnearly1/100000．ButGISTsarethemostcommonsofttissuesarcomaintheGItract．ItcanariseanywherealongtheGItractbutstomach60%andsmallintestine30%arethemostcommonsitesfollowedbycolorectal5%to6%primarysiterectum4%andcolon1%～2%．Thisreviewconsistsofoverviewdiagnosisprincipleofsurgerypostoperativerecurrenceriskassessmenttargetedtherapyandfollowupbasedon2014NCCNguidelinesversiononsofttissuesarcomaand2014ESMOguidelinesversiononGISTs．WehopethatitDOI10．3877/[e-mail]201541ChinJColorecDisElectronicEdition2015Vol．4No．1·9·willofferalittlehelptogastroenterologyespeciallytothesurgeons．【Keywords】GastrointestinalstromaltumorsDiagnosisSurgicalproceduresoperativeFollow-UpstudiesTargetedtherapy、GISTs1/100000。GISTs1。60～65。。GISTsKITPDGFＲA2。GISTs60%30%4～5%、4%、1～2%1%。、、、、。。GISTs。。、/CT/MＲIMＲIGISTsPET-CT/MＲI。GISTs3。EUS-FNA。。GISTs。GISTs。GISTs、。。CD117CD34GISTs。1GIST·10·201541ChinJColorecDisElectronicEdition2015Vol．4No．12GIST3GISTCD3470%、SMA25%desmin5%。KITPDGFＲA80%GISTsKIT。CD117/CD34GISTs。10～15%GISTsKITPDGFＲAGISTs。KITPDGFＲASDHBＲAF。1GISTGIST23501～3。、GISTs。、、、。201541ChinJColorecDisElectronicEdition2015Vol．4No．1·11·4。1．2cm2cmGIST。EUS、、4。2．2cm2cm。GIST。42cm52cm·12·201541ChinJColorecDisElectronicEdition2015Vol．4No．151GIST。GIST。2。3Ｒ0。4。。5。NCCNＲ1。ESMOＲ0。GISTs6GIST。、、、GIST。5。、TNMGISTs、、1～2。、GISTKITGISTKITGIST。36。。-。GIST。SDHGISTGISTESMO。KITGIST。ⅡⅢ/GIST50%PFS。GISTCＲPＲ935%38%。B222。400mg/day800mg/day6～7。1≤2cm≤5/50HPFs02cm＜≤10cm≤5/50HPFs＜4%≤5cm＞5/50HPFs-12%-15%＞10cm≤5/50HPFs＞5cm＞5/50HPFs49%-86%2≤2cm≤5/50HPFs02cm＜≤5cm≤5/50HPFs＜4%≤5cm＞5/50HPFs-25%5cm＜≤10cm≤5/50HPFs＞10cm＞5/50HPFs50%-90%201541ChinJColorecDisElectronicEdition2015Vol．4No．1·13·6GIST7·14·201541ChinJColorecDisElectronicEdition2015Vol．4No．17GIST。。400mg/KIT9800mg/。8～12CTCT。。。、、、、、、、。。。。KIT。8。、。、、、、、。。TSH。。。160mg/day。9。10。、GIST3～6/CT11-12。1NilssonBBummingPMeis-KindblomJMetal．Gastrointestinalstromaltumorstheincidenceprevalenceclinicalcourseandprognosticationinthepre-imatinibmesylateera-apopulationbasedstudyinwesternSweden．Cancer2005103821-829．2PappoASJanewayKA．Pediatricgastrointestinalstromaltumors．HematolOncolClinNorthAm20092315-34．3ＲubinBPBlankeCDDemetriGDetal．Protocolfortheexaminationofspecimensfrompatientswithgastrointestinalstromaltumor．ArchPatholLabMed2010134165-170．4MiettinenMLasotaJ．Gastrointestinalstromaltumorspathologyandprognosisatdifferentsites．SeminDiagnPathol200623270-83．5DemetriGDvonMehrenMAntonescuCＲetal．NCCNTaskForcereportupdateonthemanagementofpatientswithgastrointestinalstromaltumors．JNatlComprCancNetw20102S1-41S42-4．6OhtaniHMaedaKNodaEetal．Meta-analysisoflaparoscopicandopensurgeryforgastricgastrointestinalstromaltumor．AnticancerＲes2013335031-5041．7Gastrointestinalstromaltumormeta-analysisgroupMetaGIST．Comparisonoftwodosesofimatinibforthetreatmentofunresectableormetastaticgastrointestinalstromaltumorsameta-analysisof1640patients．JClinOncol2010281247-1253．8DemetriGDvanOosteromATGarrettCＲetal．Efficacyandsafetyofsunitinibinpatientswithadvancedgastrointestinalstromaltumorafterfailureofimatinibarandomisedcontrolledtrial．Lancet20063681329-1338．9DemetriGDＲeichardtPKangYKetal．OnbehalfofallGＲIDstudyinvestigators．EfficacyandsafetyofregorafenibforadvancedgastrointestinalstromaltumoursafterfailureofimatinibandsunitinibGＲIDaninternationalmulticentrerandomisedplacebo-controlledphase3trial．Lancet2013381295-302．10KangYKＲyuMHYooCetal．ＲesumptionofimatinibtocontrolmetastaticorunresectablegastrointestinalstromaltumoursafterfailureofimatinibandsunitinibＲIGHTarandomisedplacebo-controlledphase3trial．LancetOncol2013141175-1182．11ESMO/EuropeanSarcomaNetworkWorkingGroup．GastrointestinalstromaltumoursESMOClinicalPracticeGuidelinesfordiagnosistreatmentandfollow-up．AnnOncol2014321-26．12vonMehrenMＲandallＲLNationalComprehensiveCancerNetworketal．Softtissuesarcomaversion2．2014．JNatlComprCancNetw2014124473-483．2014-11-06．J/CD．2015418-14．