Department of Surgery, Division of Frontier Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima 734-8551, Japan.
World J Surg Oncol. 2012 Feb 20;10:43. doi: 10.1186/1477-7819-10-43.
Gastrointestinal stromal tumors (GISTs) are morphologically and clinically heterogeneous tumors, and their biological behavior is difficult to predict, ranging from clinically benign to malignant. The aim of our study was to reanalyze the value of the commonly used prognostic criteria and recently reported nomogram in predicting disease recurrence in patients with primary resectable GISTs.
The clinicopathological features of 60 patients with GISTs who underwent surgical resection between 1998 and 2010 at Hiroshima University Hospital were retrospectively reviewed. Tumors were classified according to the National Institutes of Health and Armed Forces Institute of Pathology criteria, and nomogram predictions were performed. The relationship between patient and tumor characteristics was tested by univariate analysis using the log-rank test. Furthermore, we assessed nomogram performance with the concordance index and calibration.
The median patient follow-up was 4.1 years, with 6 of 60 patients experiencing recurrence. Recurrence was observed only in the high-risk group. The recurrence-free survival (RFS) was 93.0 and 89.9% after 2 and 5 years, respectively. The concordance indices of the nomogram prediction were 0.96 and 0.65 for all patients and the high-risk subgroup, respectively. Calibration of the nomogram-predicted RFS tended to overestimate the recurrence risk relative to the actual RFS.
Although the commonly used criteria provide an excellent estimation of tumor behavior, they are limited by prognostic heterogeneity. The predictive nomogram is a beneficial scoring system but not a direct RFS predictor. We need more consideration for small GISTs, particularly those less than 3 cm in diameter, and small GISTs should be analyzed as a subset with potentiality different biological behavior.
胃肠道间质瘤（GISTs）是形态和临床均具有异质性的肿瘤，其生物学行为难以预测，从临床良性到恶性不等。我们的研究目的是重新分析常用的预后标准和最近报道的列线图在预测原发性可切除 GIST 患者疾病复发中的价值。
回顾性分析了 1998 年至 2010 年在广岛大学医院接受手术切除的 60 例 GIST 患者的临床病理特征。根据美国国立卫生研究院和武装部队病理学研究所的标准对肿瘤进行分类，并进行列线图预测。使用对数秩检验对单变量分析进行了患者和肿瘤特征之间的关系测试。此外，我们使用一致性指数和校准评估了列线图的性能。
中位患者随访时间为 4.1 年，60 例患者中有 6 例出现复发。仅在高危组观察到复发。无复发生存率（RFS）分别为 2 年和 5 年后的 93.0%和 89.9%。列线图预测的一致性指数在所有患者和高危亚组中分别为 0.96 和 0.65。列线图预测的 RFS 校准倾向于高估实际 RFS 的复发风险。
尽管常用标准提供了对肿瘤行为的出色估计，但它们受到预后异质性的限制。预测列线图是一种有益的评分系统，但不是直接的 RFS 预测器。我们需要更多地考虑小 GISTs，特别是直径小于 3cm 的小 GISTs，并且应将小 GISTs分析为具有不同生物学行为潜力的亚组。
