Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients.
Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients.
复制标题
胃肠道间质肿瘤手术切除后有条件的无病生存期：502例患者的多机构分析。
DOI：
10.1001/jamasurg.2014.2881
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发表时间：
2015-04
期刊：
影响因子：
16.9
通讯作者：
Pawlik TM
中科院分区：
文献类型：
--
作者：
Bischof DA;Kim Y;Dodson R;Jimenez MC;Behman R;Cocieru A;Fisher SB;Groeschl RT;Squires MH 3rd;Maithel SK;Blazer DG 3rd;Kooby DA;Gamblin TC;Bauer TW;Quereshy FA;Karanicolas PJ;Law CH;Pawlik TM
胃肠道间质瘤（GIST）是最常诊断的胃肠道间叶质肿瘤。胃肠道间质瘤手术切除后的复发风险通常从手术之日起报告。然而，随着时间的推移，无病生存 (DFS) 是动态的，并且根据手术后已经积累的无病时间而变化。评估已建立的 GIST 复发风险预后评分系统的比较性能，并描述 GIST 手术切除后的条件 DFS 特征。一项回顾性队列研究，纳入了 1998 年 1 月 1 日至 2012 年 12 月 31 日期间在美国和加拿大 7 个主要学术癌症中心接受原发性非转移性 GIST 手术的 502 名患者。根据5个预后评分系统对患者的无病生存进行分类，包括美国国立卫生研究院标准、改良的美国国立卫生研究院标准、纪念斯隆凯特琳癌症中心GIST列线图以及美国癌症联合委员会胃和非胃类别。已建立的 GIST 复发风险预后评分系统的一致性指数（也称为 C 统计量或受试者工作曲线下面积）。计算了条件 DFS 估计值。 GIST 切除后总体 1 年、3 年和 5 年 DFS 分别为 95%、83% 和 74%。所有预后评分系统均具有良好的预后能力。对于所有肿瘤部位，美国癌症联合委员会胃分类表现出最好的区分度（C = 0.79）。使用条件 DFS，假设患者在 1 年、3 年和 5 年无病，那么再保持 3 年无病的概率分别为 82%、89% 和 92%。随着时间的推移，初始复发风险最高的患者的条件生存率增加幅度最大。胃肠道间质瘤切除后，有条件的 DFS 会随着时间的推移而改善。这是关于长期预后的有价值的信息，可以传达给术后一段时间后无病的患者。
Gastrointestinal stromal tumors (GISTs) are the most commonly diagnosed mesenchymal tumors of the gastrointestinal tract. The risk of recurrence following surgical resection of GISTs is typically reported from the date of surgery. However, disease-free survival (DFS) over time is dynamic and changes based on disease-free time already accumulated following surgery. To assess the comparative performance of established GIST recurrence risk prognostic scoring systems and to characterize conditional DFS following surgical resection of GISTs. A retrospective cohort study of 502 patients who underwent surgery for a primary, nonmetastatic GIST between January 1, 1998, and December 31, 2012, at 7 major academic cancer centers in the United States and Canada. Disease-free survival of the patients was classified according to 5 prognostic scoring systems, including the National Institutes of Health criteria, modified National Institutes of Health criteria, Memorial Sloan Kettering Cancer Center GIST nomogram, and American Joint Committee on Cancer gastric and nongastric categories. The concordance index (also known as the C statistic or the area under the receiver operating curve) of established GIST recurrence risk prognostic scoring systems. Conditional DFS estimates were calculated. Overall 1-year, 3-year, and 5-year DFS following resection of GISTs was 95%, 83%, and 74%, respectively. All the prognostic scoring systems had fair prognostic ability. For all tumor sites, the American Joint Committee on Cancer gastric category demonstrated the best discrimination (C = 0.79). Using conditional DFS, the probability of remaining disease free for an additional 3 years given that a patient was disease free at 1 year, 3 years, and 5 years was 82%, 89%, and 92%, respectively. Patients with the highest initial recurrence risk demonstrated the greatest increase in conditional survival as time elapsed. Conditional DFS improves over time following resection of GISTs. This is valuable information about long-term prognosis to communicate to patients who are disease free after a period following surgery.