Schmieder Michael, Henne-Bruns Doris, Mayer Benjamin, Knippschild Uwe, Rolke Claudia, Schwab Matthias, Kramer Klaus
Department of Internal Medicine, Alb-Fils-Kliniken Göppingen, Germany.
Department of General and Visceral Surgery, University Hospital Ulm Ulm, Germany.
Front Pharmacol. 2016 Dec 27;7:504. doi: 10.3389/fphar.2016.00504. eCollection 2016.
Due to adjuvant treatment concepts for patients with R0-resected gastrointestinal stromal tumors (GIST), a reproducible and reliable risk classification system proved of utmost importance for optimal treatment of patients and prediction of prognosis. The aim of this study was to reevaluate the impact of five widely-applied and well-established GIST risk classification systems (i.e., scores by Fletcher, Miettinen, Huang, Joensuu, and TNM classification) on a series of 558 GIST patients with long-term follow-up after R0 resection. Tumor size, mitotic count and site were used in variable combination to predict high- and low risk patients by the use of the five risk classification models. For survival analyses disease-specific survival, disease-free survival and overall-survival were investigated. Patients with initial metastatic disease or incompletely resectable tumors were excluded. All GIST classification models distinguished well between patients with high-risk and low-risk tumors and none of the five risk systems was superior to predict patient outcome. The models showed significant heterogeneity. There was no significant difference between the different risk-groups regarding overall-survival. Subdivision of GIST patients with very low- and low-risk appeared to be negligible. Currently applied GIST risk classification systems are comparable to predict high- or low-risk patients with initial non-metastatic and completely resected GIST. However, the heterogeneity of the high-risk group and the absence of differences in overall survival indicate the need for more precise tumor- and patient-related criteria for better stratification of GIST and identification of patients who would benefit best from adjuvant tyrosine kinase inhibitor therapy.
由于R0切除的胃肠道间质瘤（GIST）患者的辅助治疗理念，一个可重复且可靠的风险分类系统对于患者的最佳治疗和预后预测至关重要。本研究的目的是重新评估五个广泛应用且成熟的GIST风险分类系统（即Fletcher、Miettinen、Huang、Joensuu评分以及TNM分类）对558例R0切除后接受长期随访的GIST患者的影响。通过使用这五个风险分类模型，将肿瘤大小、有丝分裂计数和部位以不同组合用于预测高风险和低风险患者。对于生存分析，研究了疾病特异性生存、无病生存和总生存。排除初始有转移性疾病或肿瘤切除不完全的患者。所有GIST分类模型在高风险和低风险肿瘤患者之间区分良好，五个风险系统中没有一个在预测患者预后方面更具优势。这些模型显示出显著的异质性。不同风险组之间的总生存没有显著差异。极低风险和低风险GIST患者的细分似乎可忽略不计。目前应用的GIST风险分类系统在预测初始非转移性且完全切除的GIST的高风险或低风险患者方面具有可比性。然而，高风险组的异质性以及总生存无差异表明需要更精确的肿瘤和患者相关标准，以便更好地对GIST进行分层，并识别最能从辅助酪氨酸激酶抑制剂治疗中获益的患者。
