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

Abstract

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.