A nomogram to predict disease-free survival after surgical resection of GIST.
A nomogram to predict disease-free survival after surgical resection of GIST.
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DOI：
10.1007/s11605-014-2658-2
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发表时间：
2014-12
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影响因子：
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通讯作者：
Pawlik TM
中科院分区：
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作者：
Bischof DA;Kim Y;Behman R;Karanicolas PJ;Quereshy FA;Blazer DG 3rd;Maithel SK;Gamblin TC;Bauer TW;Pawlik TM
胃肠道间质瘤（GIST）是胃肠道最常见的间叶性肿瘤。伊马替尼辅助治疗可改善原发性GIST切除后的无病生存期（DFS）。我们研究的目的是建立一个诺模图来预测GIST切除后的DFS。使用1998年1月至2012年12月期间在美国和加拿大的7家学术医院接受原发性GIST手术的多机构患者队列，使用向后逐步选择创建预测DFS的多变量考克斯比例风险模型。用多变量模型中选择的变量构建了预测GIST手术切除后DFS的列线图。我们通过计算C-统计量来测试诺模图的区分，并将诺模图与四个现有的GIST预后分层系统进行比较。共有365例因原发性GIST接受手术的患者纳入本研究。使用向后逐步选择，性别，肿瘤大小，肿瘤部位和有丝分裂率被选择纳入诺模图。与NIH标准、改良NIH标准和Memorial Sloan-Kettering列线图相比，列线图显示出上级区分度，与Miettinen标准具有相似的区分度（C-统计量分别为0.77 vs 0.73、0.71、0.71和0.78）。四个独立的预测复发的术后原发性胃肠道间质瘤被用来创建一个诺模图预测DFS。列线图将患者分为预后组，并在内部验证中表现良好。
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy has resulted in improved disease-free survival (DFS) following resection of primary GIST. The aim of our study was to create a nomogram to predict DFS following resection of GIST. Using a multi-institutional cohort of patients who underwent surgery for primary GIST at 7 academic hospitals in the USA and Canada between January 1998 and December 2012, a multivariable Cox proportional hazards model predicting DFS was created using backward stepwise selection. A nomogram to predict DFS following surgical resection of GIST was constructed with the variables selected in the multivariable model. We tested nomogram discrimination by calculating the C-statistic and compared the nomogram to four existing GIST prognostic stratification systems. A total of 365 patients who underwent surgery for primary GIST was included in the study. Using backward stepwise selection, sex, tumor size, tumor site, and mitotic rate were selected for incorporation into the nomogram. The nomogram demonstrated superior discrimination compared to the NIH criteria, modified NIH criteria, and Memorial Sloan-Kettering Nomogram and had similar discrimination to the Miettinen criteria (C-statistic 0.77 vs 0.73, 0.71, 0.71, and 0.78, respectively). Four independent predictors of recurrence following surgery for primary GIST were used to create a nomogram to predict DFS. The nomogram stratified patients into prognostic groups and performed well on internal validation.