Liu Xuechao, Lin Enyu, Sun Yuqi, Liu Xiaodong, Li Zequn, Jiao Xuelong, Li Yi, Guo Dong, Zhang Peng, Feng Xingyu, Chen Tao, Niu Zhaojian, Zhou Zhiwei, Qiu Haibo, Zhou Yanbing
Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Med (Lausanne). 2022 Mar 10;9:777181. doi: 10.3389/fmed.2022.777181. eCollection 2022.
Adjuvant imatinib therapy has been shown to improve overall survival (OS) of gastrointestinal stromal tumor (GIST) significantly. Few nomograms combining the use of adjuvant imatinib and clinicopathological characteristics estimate the outcome of patients. We aimed to establish a more comprehensive nomogram for predicting OS in patients with GIST.
In total, 1310 GIST patients undergoing curative resection at four high-volume medical centers between 2001 and 2015 were enrolled. Independent prognostic factors were identified by multivariate Cox analysis. Eligible patients were randomly assigned in a ratio of 7:3 into a training set (916 cases) and a validation set (394 cases). A nomogram was established by R software and its predictive power compared with that of the modified National Institutes of Health (NIH) classification using time-dependent receiver operating characteristic (ROC) curves and calibration plot.
Age, tumor site, tumor size, mitotic index, postoperative imatinib and diagnostic delay were identified as independent prognostic parameters and used to construct a nomogram. Of note, diagnostic delay was for the first time included in a prognostic model for GIST. The calibrated nomogram resulted in predicted survival rates consistent with observed ones. And the decision curve analysis suggested that the nomogram prognostic model was clinically useful. Furthermore, time-dependent ROC curves showed the nomogram exhibited greater discrimination power than the modified NIH classification in 3- and 5-year survival predictions for both training and validation sets (all < 0.05).
Postoperative adjuvant imatinib therapy improved the survival of GIST patients. We developed and validated a more comprehensive prognostic nomogram for GIST patients, and it could have important clinical utility in improving individualized predictions of survival risks and treatment decision-making.
辅助性伊马替尼治疗已被证明可显著提高胃肠道间质瘤（GIST）患者的总生存期（OS）。很少有结合辅助性伊马替尼使用和临床病理特征的列线图来评估患者的预后。我们旨在建立一个更全面的列线图来预测GIST患者的OS。
总共纳入了2001年至2015年间在四个大型医疗中心接受根治性切除的1310例GIST患者。通过多变量Cox分析确定独立预后因素。符合条件的患者按7:3的比例随机分为训练集（916例）和验证集（394例）。使用R软件建立列线图，并使用时间依赖性受试者操作特征（ROC）曲线和校准图将其预测能力与改良的美国国立卫生研究院（NIH）分类的预测能力进行比较。
年龄、肿瘤部位、肿瘤大小、有丝分裂指数、术后伊马替尼治疗和诊断延迟被确定为独立预后参数，并用于构建列线图。值得注意的是，诊断延迟首次被纳入GIST的预后模型。校准后的列线图得出的预测生存率与观察到的生存率一致。决策曲线分析表明列线图预后模型具有临床实用性。此外，时间依赖性ROC曲线显示，在训练集和验证集的3年和5年生存预测中，列线图比改良的NIH分类具有更大的辨别力（所有P<0.05）。
术后辅助性伊马替尼治疗提高了GIST患者的生存率。我们开发并验证了一个更全面的GIST患者预后列线图，它在改善生存风险的个体化预测和治疗决策方面可能具有重要的临床应用价值。
