Which is the optimal risk stratification system for surgically treated localized primary GIST? Comparison of three contemporary prognostic criteria in 171 tumors and a proposal for a modified armed forces institute of pathology risk criteria
Which is the optimal risk stratification system for surgically treated localized primary GIST? Comparison of three contemporary prognostic criteria in 171 tumors and a proposal for a modified armed forces institute of pathology risk criteria
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DOI：
10.1245/s10434-008-9969-z
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发表时间：
2008-08-01
影响因子：
3.7
通讯作者：
Wong, Wai-Keong
中科院分区：
文献类型：
--
作者：
Goh, Brian K. P.;Chow, Pierce K. H.;Wong, Wai-Keong
背景：本研究旨在验证和比较美国国立卫生研究院(NIH)标准、黄氏改良NIH标准和三军病理研究所(AFIP)胃肠道间质瘤风险标准在同一机构手术治疗的一大系列局部原发GIST中的表现，以确定理想的GIST风险分层系统。方法：回顾171例手术切除GIST患者的临床病理特征。结果：171例患者精算无复发生存率(RFS)中位数为70%。多因素分析显示，肿瘤大小>10 cm、核分裂像计数>5/50高倍视野、肿瘤坏死、浆膜受累是影响RFS预后的独立因素。所有这三个风险标准在不同阶段的复发率、中位精算RFS、精算5年RFS和肿瘤特异性死亡方面均有统计学意义的差异。结论：NIH、改良NIH和AFIP标准对胃肠道间质瘤有较好的预测价值，AFIP风险标准对原发局限性胃肠道间质瘤的预测效果最好。然而，在AFIP高危类别中存在显著的预后异质性，通过我们建议的修改，该系统提供了最准确的预后信息。
Background: This study aims to validate and compare the performance of the National Institute of Health (NIH) criteria, Huang modified NIH criteria, and Armed Forces Institute of Pathology (AFIP) risk criteria for gastrointestinal stromal tumors (GISTs) in a large series of localized primary GISTs surgically treated at a single institution to determine the ideal risk stratification system for GIST.Methods: The clinicopathological features of 171 consecutive patients who underwent surgical resection for GISTs were retrospectively reviewed. Statistical analyses were performed to compare the prognostic value of the three risk criteria by analyzing the discriminatory ability linear trend, homogeneity, monotonicity of gradients, and Akaike information criteria.Results: The median actuarial recurrence-free survival (RFS) for all 171 patients was 70%. On multivariate analyses, size > 10 cm, mitotic count > 5/50 high-power field, tumor necrosis, and serosal involvement were independent prognostic factors of RFS. All three risk criteria demonstrated a statistically significant difference in the recurrence rate, median actuarial RFS, actuarial 5-year RFS, and tumor-specific death across the different stages. Comparison of the various risk-stratification systems demonstrated that our proposed modified AFIP criteria had the best independent predictive value of RFS when compared with the other systems.Conclusion: The NIH, modified NIH, and AFIP criteria are useful in the prognostication of GIST, and the AFIP risk criteria provided the best prognostication among the three systems for primary localized GIST. However, remarkable prognostic heterogeneity exists in the AFIP high-risk category, and with our proposed modification, this system provides the most accurate prognostic information.