Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts
Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts
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DOI：
10.1016/s1470-2045(11)70299-6
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发表时间：
2012-03-01
期刊：
影响因子：
51.1
通讯作者：
Rutkowski, Piotr
中科院分区：
文献类型：
--
作者：
Joensuu, Heikki;Vehtari, Aki;Rutkowski, Piotr
背景胃肠道间质瘤（GIST）手术后复发的风险需要估计时，考虑辅助全身治疗。我们评估了预后因素与可操作的胃肠道间质瘤的患者，比较广泛使用的风险分层方案，并制定一个新的方法进行风险estimation.Methods人群为基础的队列诊断与可操作的胃肠道间质瘤，谁没有得到辅助治疗的患者，从文献中确定。汇总了10个系列和2560例患者的数据。肿瘤复发的风险分层使用国家卫生研究院（NIH）的共识标准，修改后的共识标准，和武装部队病理研究所（AFIP）的标准。使用比例风险和非线性模型检查预后因素。结果在一个独立的中心为基础的队列，包括920例GIST.Findings估计15年无复发生存率（RFS）手术后为59.9%（95%CI 56.2-63.6），很少复发发生后的第一个10年的后续行动。肿瘤体积大、有丝分裂计数高、非胃部位、破裂和男性是独立的不良预后因素。在10年RFS的受试者工作特征曲线分析中，NIH共识标准、改良共识标准和AFIP标准得出的曲线下面积（AUC）分别为0.79（95% CI 0.76-0.81）、0.78（0.75-0.80）和0.82（0.80-0.85）。修改后的共识标准确定了一个单一的高风险群体。由于肿瘤大小和有丝分裂计数与GIST复发风险呈非线性相关，因此使用肿瘤大小和有丝分裂计数的非线性模型并考虑肿瘤部位和破裂情况，生成新的预后等高线图。非线性模型准确地预测了复发的风险（AUC 0.88，0.86-0.90）。解释评估的风险分层方案确定了可能仅通过手术治愈的患者。虽然改良的NIH分类是确定单个高危组以考虑辅助治疗的最佳标准，但非线性建模产生的预后等高线图适用于估计个体化结局。
Background The risk of recurrence of gastrointestinal stromal tumour (GIST) after surgery needs to be estimated when considering adjuvant systemic therapy. We assessed prognostic factors of patients with operable GIST, to compare widely used risk-stratification schemes and to develop a new method for risk estimation.Methods Population-based cohorts of patients diagnosed with operable GIST, who were not given adjuvant therapy, were identified from the literature. Data from ten series and 2560 patients were pooled. Risk of tumour recurrence was stratified using the National Institute of Health (NIH) consensus criteria, the modified consensus criteria, and the Armed Forces Institute of Pathology (AFIP) criteria. Prognostic factors were examined using proportional hazards and non-linear models. The results were validated in an independent centre-based cohort consisting of 920 patients with GIST.Findings Estimated 15-year recurrence-free survival (RFS) after surgery was 59.9% (95% CI 56.2-63.6); few recurrences occurred after the first 10 years of follow-up. Large tumour size, high mitosis count, non-gastric location, presence of rupture, and male sex were independent adverse prognostic factors. In receiver operating characteristics curve analysis of 10-year RFS, the NIH consensus criteria, modified consensus criteria, and AFIP criteria resulted in an area under the curve (AUC) of 0.79 (95% CI 0.76-0.81), 0.78 (0.75-0.80), and 0.82 (0.80-0.85), respectively. The modified consensus criteria identified a single high-risk group. Since tumour size and mitosis count had a nonlinear association with the risk of GIST recurrence, novel prognostic contour maps were generated using non-linear modelling of tumour size and mitosis count, and taking into account tumour site and rupture. The non-linear model accurately predicted the risk of recurrence (AUC 0.88, 0.86-0.90).Interpretation The risk-stratification schemes assessed identify patients who are likely to be cured by surgery alone. Although the modified NIH classification is the best criteria to identify a single high-risk group for consideration of adjuvant therapy, the prognostic contour maps resulting from non-linear modelling are appropriate for estimation of individualised outcomes.