BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy has resulted in improved disease-free survival (DFS) following resection of primary GIST. The aim of our study was to create a nomogram to predict DFS following resection of GIST. METHOD: Using a multi-institutional cohort of patients who underwent surgery for primary GIST at 7 academic hospitals in the USA and Canada between January 1998 and December 2012, a multivariable Cox proportional hazards model predicting DFS was created using backward stepwise selection. A nomogram to predict DFS following surgical resection of GIST was constructed with the variables selected in the multivariable model. We tested nomogram discrimination by calculating the C-statistic and compared the nomogram to four existing GIST prognostic stratification systems. RESULTS: A total of 365 patients who underwent surgery for primary GIST was included in the study. Using backward stepwise selection, sex, tumor size, tumor site, and mitotic rate were selected for incorporation into the nomogram. The nomogram demonstrated superior discrimination compared to the NIH criteria, modified NIH criteria, and Memorial Sloan-Kettering Nomogram and had similar discrimination to the Miettinen criteria (C-statistic 0.77 vs 0.73, 0.71, 0.71, and 0.78, respectively). CONCLUSION: Four independent predictors of recurrence following surgery for primary GIST were used to create a nomogram to predict DFS. The nomogram stratified patients into prognostic groups and performed well on internal validation.
BACKGROUND:Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy has resulted in improved disease-free survival (DFS) following resection of primary GIST. The aim of our study was to create a nomogram to predict DFS following resection of GIST. METHOD: Using a multi-institutional cohort of patients who underwent surgery for primary GIST at 7 academic hospitals in the USA and Canada between January 1998 and December 2012, a multivariable Cox proportional hazards model predicting DFS was created using backward stepwise selection. A nomogram to predict DFS following surgical resection of GIST was constructed with the variables selected in the multivariable model. We tested nomogram discrimination by calculating the C-statistic and compared the nomogram to four existing GIST prognostic stratification systems. RESULTS: A total of 365 patients who underwent surgery for primary GIST was included in the study. Using backward stepwise selection, sex, tumor size, tumor site, and mitotic rate were selected for incorporation into the nomogram. The nomogram demonstrated superior discrimination compared to the NIH criteria, modified NIH criteria, and Memorial Sloan-Kettering Nomogram and had similar discrimination to the Miettinen criteria (C-statistic 0.77 vs 0.73, 0.71, 0.71, and 0.78, respectively). CONCLUSION: Four independent predictors of recurrence following surgery for primary GIST were used to create a nomogram to predict DFS. The nomogram stratified patients into prognostic groups and performed well on internal validation.
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Authors: Heikki Joensuu; Aki Vehtari; Jaakko Riihimäki; Toshirou Nishida; Sonja E Steigen; Peter Brabec; Lukas Plank; Bengt Nilsson; Claudia Cirilli; Chiara Braconi; Andrea Bordoni; Magnus K Magnusson; Zdenek Linke; Jozef Sufliarsky; Massimo Federico; Jon G Jonasson; Angelo Paolo Dei Tos; Piotr Rutkowski Journal: Lancet Oncol Date: 2011-12-06 Impact factor: 41.316
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Authors: Bengt Nilsson; Per Bümming; Jeanne M Meis-Kindblom; Anders Odén; Aydin Dortok; Bengt Gustavsson; Katarzyna Sablinska; Lars-Gunnar Kindblom Journal: Cancer Date: 2005-02-15 Impact factor: 6.860
Authors: Charles E Woodall; Guy N Brock; Jie Fan; Jerome A Byam; Charles R Scoggins; Kelly M McMasters; Robert C G Martin Journal: Arch Surg Date: 2009-07
Authors: Christopher D M Fletcher; Jules J Berman; Christopher Corless; Fred Gorstein; Jerzy Lasota; B Jack Longley; Markku Miettinen; Timothy J O'Leary; Helen Remotti; Brian P Rubin; Barry Shmookler; Leslie H Sobin; Sharon W Weiss Journal: Hum Pathol Date: 2002-05 Impact factor: 3.466
Authors: Ronald P Dematteo; Karla V Ballman; Cristina R Antonescu; Robert G Maki; Peter W T Pisters; George D Demetri; Martin E Blackstein; Charles D Blanke; Margaret von Mehren; Murray F Brennan; Shreyaskumar Patel; Martin D McCarter; Jonathan A Polikoff; Benjamin R Tan; Kouros Owzar Journal: Lancet Date: 2009-03-18 Impact factor: 79.321