A Novel Pathological Prognostic Score (PPS) to Identify "Very High-Risk" Patients: a Multicenter Retrospective Analysis of 506 Patients with High Risk Gastrointestinal Stromal Tumor (GIST)
A Novel Pathological Prognostic Score (PPS) to Identify "Very High-Risk" Patients: a Multicenter Retrospective Analysis of 506 Patients with High Risk Gastrointestinal Stromal Tumor (GIST)
复制标题
用于识别“极高风险”患者的新型病理预后评分 (PPS)：对 506 名高风险胃肠道间质瘤 (GIST) 患者的多中心回顾性分析
DOI：
10.1007/s11605-018-3799-5
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发表时间：
2018-12-01
影响因子：
3.2
通讯作者：
Zhou, Zhiwei
中科院分区：
文献类型：
--
作者：
Liu, Xuechao;Qiu, Haibo;Zhou, Zhiwei
目的：探讨基于手术病理的高危分级方法，并应用新的评分系统评价高危胃肠道间质瘤（GIST）患者根治性切除术后的临床预后。方法回顾性分析2001年至2015年在4个中心接受根治性切除作为初始治疗的506例高危GIST患者。结果多因素分析显示Ki-67标记指数（LI）和有丝分裂指数（mitotic index）是影响总生存期（OS）的独立预后因素。两种肿瘤相关病理因子Ki-67 LI >= 7%，有丝分裂指数>= 7/50高倍视场各1分。总得分定义为病理预后评分（PPS）。当Ki-67 LI和有丝分裂指数被PPS取代时，多变量分析仍然确定PPS是OS的独立预测因子（HR 2.719; 95% CI 1.304 -5.650; P = 0.007）。PPS为0、1或2的患者的5年生存率分别为91.8%、79.8和51.0% （P = 0.001）。此外，PPS升高（PPS = 2）与肿瘤较大、非胃肿瘤和开放切除相关（均P < 0.05）。结论PPS可独立预测高危GIST患者的术后生存，有助于选择合适的治疗策略。
Background To determine the better risk stratification based on surgical pathology and to assess the clinical outcomes after curative resection with a new scoring system in high risk gastrointestinal stromal tumor (GIST) patients.Methods We retrospectively evaluated 506 high-risk GIST patients who underwent curative resection as initial treatment at four centers from 2001 to 2015.Results Multivariate analysis revealed that only Ki-67 labeling index (LI) and mitotic index were independent prognostic factors of overall survival (OS). For the two tumor-related pathological factors, Ki-67 LI > 7% and mitotic index >= 7/50 high power fields were allocated 1 point each. The total score was defined as the Pathological Prognostic Score (PPS). When Ki-67 LI and mitotic index were replaced by PPS, a multivariate analysis still identified PPS as an independent predictor of OS (HR 2.719; 95% CI 1.309-5.650; P = 0.007). Patients with a PPS of 0, 1, or 2 had a 5-year survival of 91.8, 79.8, and 51.0%, respectively (P = 0.001). Furthermore, an elevated PPS (PPS = 2) was associated with larger tumor size, non-stomach tumor, and open resection (all P < 0.05).Conclusion The PPS independently predicted postoperative survival in high-risk GIST, and it might facilitate the selection of appropriate treatment strategy for these patients.