胃肠道间质瘤手术切除后的无病生存情况：502例患者的多机构分析
Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients.
作者信息
Bischof Danielle A, Kim Yuhree, Dodson Rebecca, Jimenez M Carolina, Behman Ramy, Cocieru Andrei, Fisher Sarah B, Groeschl Ryan T, Squires Malcolm H, Maithel Shishir K, Blazer Dan G, Kooby David A, Gamblin T Clark, Bauer Todd W, Quereshy Fayez A, Karanicolas Paul J, Law Calvin H L, Pawlik Timothy M
机构信息
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.
University Health Network, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
出版信息
JAMA Surg. 2015 Apr;150(4):299-306. doi: 10.1001/jamasurg.2014.2881.
IMPORTANCE
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.
OBJECTIVES
To assess the comparative performance of established GIST recurrence risk prognostic scoring systems and to characterize conditional DFS following surgical resection of GISTs.
DESIGN, SETTING, AND PARTICIPANTS: 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.
MAIN OUTCOMES AND MEASURES
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.
RESULTS
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.
CONCLUSIONS AND RELEVANCE
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.
重要性
胃肠道间质瘤（GIST）是胃肠道最常被诊断出的间叶组织肿瘤。GIST手术切除后的复发风险通常从手术日期开始报告。然而，无病生存期（DFS）随时间是动态变化的，且会根据手术后已积累的无病时间而改变。
目的
评估已确立的GIST复发风险预后评分系统的比较性能，并描述GIST手术切除后的条件性DFS。
设计、设置和参与者：一项对1998年1月1日至2012年12月31日期间在美国和加拿大7家主要学术癌症中心接受原发性、非转移性GIST手术的502例患者进行的回顾性队列研究。
主要结局和测量指标
根据5种预后评分系统对患者的无病生存期进行分类，包括美国国立卫生研究院标准、改良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分类。已确立的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特征曲线下面积）。计算条件性DFS估计值。
结果
GIST切除后的总体1年、3年和5年DFS分别为95%、83%和74%。所有预后评分系统的预后能力中等。对于所有肿瘤部位，美国癌症联合委员会胃分类显示出最佳的区分度（C = 0.79）。使用条件性DFS，若患者在1年、3年和5年时无病，那么再无病生存3年的概率分别为82%、89%和92%。初始复发风险最高的患者随着时间推移条件性生存的增加幅度最大。
结论及相关性
GIST切除后的条件性DFS随时间改善。这是关于长期预后的有价值信息，可传达给术后一段时间无病的患者。
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