Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Medical Oncology, National Cancer Center, Singapore.
Eur J Surg Oncol. 2018 Apr;44(4):388-394. doi: 10.1016/j.ejso.2017.12.006. Epub 2018 Jan 9.
The advent of tyrosine kinase inhibitors as adjuvant therapy has revolutionized the management of GIST and emphasized the need for accurate prognostication systems. Numerous prognostication systems have been proposed for GIST but at present it remains unknown which system is superior. The present systematic review aims to summarize current prognostication systems for primary treatment-naive GIST.
A literature review of the Pubmed and Embase databases was performed to identify all published articles in English, from the 1st January 2002 to 28th Feb 2017, reporting on clinical prognostication systems of GIST.
Twenty-three articles on GIST prognostication systems were included. These systems were classified as categorical systems, which stratify patients into risk groups, or continuous systems, which provide an individualized form of risk assessment. There were 16 categorical systems in total. There were 4 modifications of the National Institute of Health (NIH) system, 2 modifications of Armed Forces Institute of Pathology (AFIP) criteria and 3 modifications of Joensuu (modified NIH) criteria. Of the 7 continuous systems, there were 3 prognostic nomograms, 3 mathematical models and 1 prognostic heat/contour maps. Tumor size, location and mitotic count remain the main variables used in these systems.
Numerous prognostication systems have been proposed for the risk stratification of GISTs. The most widely used systems today are the NIH, Joensuu modified NIH, AFIP and the Memorial Sloan Kettering Cancer Center nomogram. More validation and comparison studies are required to determine the optimal prognostication system for GIST.
酪氨酸激酶抑制剂作为辅助治疗药物的出现彻底改变了 GIST 的治疗模式，凸显了建立准确预后预测系统的必要性。目前已经提出了许多 GIST 的预后预测系统，但尚不清楚哪种系统更为优越。本系统综述旨在总结目前用于初治 GIST 的预后预测系统。
对 Pubmed 和 Embase 数据库进行文献检索，以确定从 2002 年 1 月 1 日至 2017 年 2 月 28 日发表的所有关于 GIST 临床预后预测系统的英文文章。
共纳入 23 篇关于 GIST 预后预测系统的文章。这些系统分为分类系统，将患者分为风险组，或连续系统，提供个体化的风险评估形式。共有 16 个分类系统。其中包括 4 个 NIH 系统的改良版，2 个 AFIP 标准的改良版和 3 个 Joensuu（改良 NIH）标准的改良版。7 个连续系统中，有 3 个预后列线图，3 个数学模型和 1 个预后热图/等高线图。肿瘤大小、位置和有丝分裂计数仍然是这些系统中主要使用的变量。
目前已经提出了许多 GIST 风险分层的预后预测系统。目前应用最广泛的系统是 NIH、改良 NIH、AFIP 和 Memorial Sloan Kettering 癌症中心列线图。需要更多的验证和比较研究来确定 GIST 的最佳预后预测系统。
