[Similarities and differences in diagnosis and treatment of gastrointestinal stromal tumors between China, Japan and Korea: from expert consensus to cooperation prospect].

The great success of tyrosine kinase receptor inhibitor (TKI) in gastrointestinal stromal tumors(GIST) has promoted it to become a classic model of targeted cancer therapy in the era of precision medicine. Multidisciplinary diagnosis and treatment and whole-process scientific management are the key to clinical diagnosis and treatment of GIST. There are many expert consensuses or guidelines on diagnosis and treatment of GIST in the world. The English version of expert consensuses on diagnosis and treatment of GIST has been issued by the East Asian countries represented by Japan, Korea and China, respectively, in combination with their own clinical practice. In 2016, the first edition of the Asian Expert Consensus on Diagnosis and Treatment of GIST was formulated jointly by the above - mentioned countries. This paper aims to explore the similarities and differences between Chinese and Asian Consensus on the diagnosis and treatment of GIST, to improve the understanding of GIST, and to bridge the gap and explore clues for future cooperation among these countries. The overall framework of both consensuses includes the pathological diagnosis, surgery and drug treatment of GIST. The differences include the following three aspects: (1) The different focus of pathological diagnosis of GIST. The Chinese Consensus has highlighted the requirements for the management of pathological specimens of GIST and the pathological evaluation after targeted therapy. The Chinese Consensus has also tried to clarify the algorithm of diagnosis of wild-type GIST, while wild-type GIST is introduced in very few words in the Asian Consensus. (2) The difference of surgical treatment of GIST focuses on the field of minimally invasive techniques, especially the application of endoscopy in the treatment of GIST. The Asian Consensus is cautious about laparoscopic surgery and has no comments on endoscopic resection at all. At present, the Chinese Consensus does not recommend routine endoscopic treatment in GIST, but the indications have been expanded to a certain extent, reflecting the clinical needs and development trends of endoscopic therapy in China. (3) The recommendation degree of medication for GIST varies. The difference includes the indication of adjuvant therapy, the recommendation after failure of first-line treatment, and discontinuation of TKIs preoperatively, and duration of postoperative adjuvant therapy. The difference between the Chinese Consensus and the Asian Consensus reflects the gap in the practice and clinical research of GIST between China and other Asian countries (e.g. Japan and Korea). Cooperation is the main theme in the field of medical science in the 21st century. China, Japan and South Korea are all located in East Asia and have certain shared features in terms of genetic and biological background, living habits and social environment, medical system and scientific research mode. It is a good entry point to carry out international cooperation research in the field of GIST. In view of some pending problems in the diagnosis and treatment of GIST, the cooperative research between China, Japan and Korea may focus on the following aspects: (1) The value of surgery in the treatment of advanced GIST. (2) The detection of imatinib blood concentration in East Asian population and optimized rational use of targeted drugs in the oriental population. (3) Chinese researchers should optimize the strategy of endoscopic treatment of GIST, design rigorous domestic multi-center clinical trials, and provide convincing data, so as to obtain international recognition. (4) Other related studies may include the diagnosis and treatment of wild-type GIST, the value of Ki-67 in the pathological evaluation of GIST, laparoscopic surgery for gastric GIST, and the optimal duration of imatinib adjuvant therapy. Researchers in China should attach importance to the value of clinical trials, especially cooperative clinical research. Starting with improving data quality, we should welcome cooperation with an open and confident attitude and strive to promote the clinical practice and research of GIST to a new height.酪氨酸激酶受体抑制剂在胃肠间质瘤（GIST）的治疗中取得的巨大成功，推动其成为精准医疗时代肿瘤靶向治疗的经典模型。多学科诊疗和全程化科学管理是GIST临床诊疗的关键，国际和国内相继有多个GIST诊疗专家共识推出，以日本、韩国及我国为代表的东亚国家均结合自身临床实践，推出了英文版的GIST诊疗专家共识。2016年，上述国家地区的GIST专家共同制定了第一版的《亚洲GIST诊疗专家共识》（《亚洲共识》）。本文探究了《中国GIST诊断与治疗专家共识》英文版（《中国共识》）与《亚洲共识》的"异"、"同"之处。两个共识基本一致的是在整体框架上均包括了GIST的病理诊断、外科和药物治疗；不同之处包括：（1）GIST病理诊断侧重点不同，《中国共识》增加了对GIST病理标本的处理要求及靶向药物治疗后的病理学评估；尤其是野生型GIST的诊断流程图一目了然，而《亚洲共识》对于野生型GIST仅以极少文字加以介绍。（2）GIST手术治疗的差别体现在微创领域，尤其是内镜技术在GIST治疗中的应用上。《亚洲共识》对腹腔镜手术持谨慎态度，且完全没有关于内镜治疗的内容。《中国共识》目前也不推荐在GIST中常规开展内镜治疗，但适应证较前有了一定程度的拓展，反映出GIST的内镜治疗在我国的临床需求和发展趋势。（3）GIST药物治疗推荐程度不同，包括辅助治疗适应证、晚期治疗推荐顺序、术前治疗的停药时间以及术后治疗时间。从《中国共识》与《亚洲共识》的比较看，我国在GIST诊疗实践与临床研究方面与之存在的差距，主要体现在缺乏谨慎规范的治疗理念和潜心科学的临床研究。21世纪在医学科学领域，合作共赢是主旋律。中、日、韩三国同处东亚地区，从人种的遗传学和生物学背景、到生活习惯和社会环境、再到医疗制度和科研模式，都有一定的共性，要开展GIST领域的国际化合作研究是一个很好的切入点。针对GIST诊疗领域若干悬而未决的问题，开展中、日、韩三国间的合作研究重点可以围绕这几方面：（1）手术治疗在晚期GIST治疗中的应用价值是一个值得开展合作研究的方向；（2）进行中、日、韩三国的伊马替尼血药浓度检测国际合作研究，拿出东亚人群的血药浓度数据，能够优化东方人群的靶向药物合理应用；（3）我国研究者应优化GIST内镜治疗策略，设计严谨的国内多中心临床研究，拿出令人信服的数据，从而获得国际同道对该技术的认可；（4）其他相关研究还可包括野生型GIST的诊断与治疗、ki-67在GIST病理学评估中的价值、胃GIST的腹腔镜手术以及伊马替尼辅助治疗的时限探索等问题。我国研究者应当重视临床研究、尤其是合作临床研究的价值，从提高数据质量入手，以开放和自信的姿态迎接合作，努力把我国GIST临床诊疗和研究推上一个新的高度！.