[改良NIH与AFIP胃肠道间质瘤风险分层标准的比较：一项多中心回顾性研究]

[Comparison of modified NIH and AFIP risk-stratification criteria for gastrointestinal stromal tumors: A multicenter retrospective study].

作者信息

Chen Tao, Qiou Haibo, Feng Xingyu, Zhang Peng, Ye Liangying, Hu Yanfeng, Liu Hao, Yu Jiang, Tao Kaixiong, Li Yong, Zhou Zhiwei, Li Guoxin

机构信息

Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Department of Gastrointestinal and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Sep 25;20(9):1020-1024.

PMID:28900993

Abstract

OBJECTIVE

To evaluate and compare the value of Modified NIH criteria and AFIP criteria for the risk classification of gastrointestinal stromal tumors (GIST).

METHODS

Clinicopathological and follow-up data of 539 patients diagnosed as primary GIST with or without irregular tyrosine kinase inhibitors in the Nanfang Hospital(n=143), Sun Yat-sen University Cancer Center (n=138), Guangdong Provincial People's Hospital (n=102) and Wuhan Union Hospital (n=156) from January 2012 to December 2015 were retrospectively analyzed. Recurrence risks of these 539 patients were classified by the modified NIH criteria and AFIP criteria. Overall survival and tumor-free survival of patients with different risks were compared by Log-rank test and the accuracy of the two criteria in predicting postoperative recurrence was compared by receiver operating characteristic(ROC) curves.

RESULTS

Of 539 GIST patients, 283 were male and 256 were female; the age was (56.5±12.5) years old; tumors of 390 cases (72.4%) located in the stomach; tumor diameter of 178 cases (33.0%) was more than 5 cm; nuclear division number of 164 cases(30.4%) was more than 5/50 high magnification. The mean follow-up time was (37.5±13.6) months. According to the modified NIH criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 52.0, 57.0, 56.9 and 53.6 months respectively (P=0.002), and the mean tumor-free survival time was 56.0, 58.1, 58.2 and 51.2 months respectively (P=0.000). According to the AFIP criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 54.1, 57.8, 55.5 and 52.0 months respectively(P=0.015), and the mean tumor-free survival time was 57.3, 56.6, 54.9 and 50.4 months respectively(P=0.000). While predicting the risk of postoperative recurrence, the ROC curve of AFIP criteria has a larger area under the curve compared to the curve of the modified NIH criteria(0.689 vs 0.641, P<0.05).

CONCLUSION

Compared with the modified NIH criteria, AFIP criteria predicts the risk postoperative recurrence more accurately in GIST patients.

摘要

目的

评估并比较改良NIH标准和AFIP标准对胃肠道间质瘤（GIST）风险分类的价值。

方法

回顾性分析2012年1月至2015年12月在南方医院（n = 143）、中山大学肿瘤防治中心（n = 138）、广东省人民医院（n = 102）和武汉协和医院（n = 156）诊断为原发性GIST且接受或未接受不规则酪氨酸激酶抑制剂治疗的539例患者的临床病理及随访数据。采用改良NIH标准和AFIP标准对这539例患者的复发风险进行分类。通过Log-rank检验比较不同风险患者的总生存期和无瘤生存期，并通过受试者工作特征（ROC）曲线比较两种标准预测术后复发的准确性。

结果

539例GIST患者中，男性283例，女性256例；年龄为（56.5±12.5）岁；390例（72.4%）肿瘤位于胃；178例（33.0%）肿瘤直径大于5 cm；164例（30.4%）核分裂数大于5/50高倍视野。平均随访时间为（37.5±13.6）个月。根据改良NIH标准，极低、低、中、高风险患者的平均总生存期分别为52.0、57.0、56.9和53.6个月（P = 0.002），平均无瘤生存期分别为56.0、58.1、58.2和51.2个月（P = 0.000）。根据AFIP标准，极低、低、中、高风险患者的平均总生存期分别为54.1、57.8、55.5和52.0个月（P = 0.015），平均无瘤生存期分别为57.3、56.6、54.9和50.4个月（P = 0.000）。在预测术后复发风险时，AFIP标准的ROC曲线下面积大于改良NIH标准的曲线下面积（0.