Ran Pan, Tan Tao, Zhou Hui, Li Jinjin, Yang Hao, Li Juan, Zhang Jun
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Internal Medicine, Chongqing Key Laboratory of Translation Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China.
J Pers Med. 2023 Mar 10;13(3):498. doi: 10.3390/jpm13030498.
This study aimed to establish a new nomogram that predicts recurrence-free survival (RFS) after a complete surgical resection of primary localized gastrointestinal stromal tumors (GISTs); it also aimed to evaluate the discrimination, calibration, and clinical utility of the decision-making nomogram.
The clinicopathological data of patients with primary localized GISTs at the First Affiliated Hospital of Chongqing Medical University from January 2000 to June 2022 were retrospectively analyzed. The clinicopathological data were randomly split into two sets (7:3 ratio) for training and validation. Suitable variables for the construction of a nomogram for the 1-, 3-, and 5-year RFS were selected using univariate and multivariate Cox regression analyses. Receiver operating characteristic (ROC) analysis and a concordance index (C-index) were used to quantify the discrimination of the nomogram and were compared with four commonly used prognostic scoring systems: Memorial Sloan Kettering Cancer Center prognostic nomogram, National Institutes of Health-Fletcher staging system, Chen's prognostic nomogram, and Air Forces Institute of Pathology risk criteria-Miettinen staging system. The calibration and clinical utility for the decision-making nomogram were validated using calibration curves and decision curves, respectively.
In total, 641 patients were screened and analyzed in this retrospective, observational study. RFS was significantly related to tumor size, mitotic count, gender, DOG-1, and adjuvant therapy with imatinib according to the results of the multivariate and univariate Cox analyses. The nomogram was constructed using the above variables (all < 0.05) for the 1-, 3-, and 5-year RFS. In the training set, the 1-, 3-, and 5-year ROC and C-index values of the nomogram were 0.868, 0.838, 0.816, and 0.830, respectively. For internal validation, we performed model fitting on the validation set, and the 1-, 3-, and 5-year ROC and C-indices were 0.977, 0.845, 0.869, and 0.849, respectively. Among the five GIST prognostic scoring systems, our nomogram had almost all the largest area under these decision curves and had a good calibration capability.
The newly constructed nomogram based on tumor size, gender, mitotic count, DOG-1, and adjuvant treatment with imatinib exhibited an excellent performance and may serve as a prognostic scoring system to support therapeutic decision-making and individualized treatment for GISTs in China.
本研究旨在建立一种新的列线图，用于预测原发性局限性胃肠道间质瘤（GIST）完全手术切除后的无复发生存期（RFS）；同时评估该决策列线图的区分度、校准度及临床实用性。
回顾性分析2000年1月至2022年6月重庆医科大学附属第一医院原发性局限性GIST患者的临床病理资料。将临床病理资料按7:3的比例随机分为两组，分别用于训练和验证。通过单因素和多因素Cox回归分析，选择适合构建1年、3年和5年RFS列线图的变量。采用受试者操作特征（ROC）分析和一致性指数（C指数）量化列线图的区分度，并与四个常用的预后评分系统进行比较：纪念斯隆凯特琳癌症中心预后列线图、美国国立卫生研究院-弗莱彻分期系统、陈的预后列线图以及空军病理学研究所风险标准-米耶蒂宁分期系统。分别使用校准曲线和决策曲线验证决策列线图的校准度和临床实用性。
在这项回顾性观察研究中，共筛选并分析了641例患者。根据单因素和多因素Cox分析结果，RFS与肿瘤大小、有丝分裂计数、性别、DOG-1以及伊马替尼辅助治疗显著相关。使用上述变量（均P<0.05）构建了1年、3年和5年RFS的列线图。在训练集中，列线图的1年、3年和5年ROC及C指数值分别为0.868、0.838、0.816和0.830。对于内部验证，我们在验证集上进行模型拟合，1年、3年和5年的ROC及C指数分别为0.977、0.845、0.869和0.849。在五个GIST预后评分系统中，我们的列线图在这些决策曲线下的面积几乎均为最大，且具有良好的校准能力。
基于肿瘤大小、性别、有丝分裂计数、DOG-1和伊马替尼辅助治疗构建的新列线图表现优异，可作为一种预后评分系统，为中国GIST的治疗决策和个体化治疗提供支持。
