Xuechao Liu1,2, Haibo Qiu1,2, Zhiming Wu1,3, Peng Zhang4, Xingyu Feng5, Tao Chen6, Yong Li5, Kaixiong Tao4, Guoxin Li6, Xiaowei Sun7,8, Zhiwei Zhou9,10. 1. State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. 2. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, Guangdong Province, China. 3. Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China. 4. Department of General Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China. 5. Department of General Surgery, Guangdong General Hospital, Guangzhou, China. 6. Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China. 7. State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. sunxw@sysucc.org.cn. 8. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, Guangdong Province, China. sunxw@sysucc.org.cn. 9. State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. zhouzhw@sysucc.org.cn. 10. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, Guangdong Province, China. zhouzhw@sysucc.org.cn.
Abstract
BACKGROUND: To determine the better risk stratification based on surgical pathology and to assess the clinical outcomes after curative resection with a new scoring system in high risk gastrointestinal stromal tumor (GIST) patients. METHODS: We retrospectively evaluated 506 high-risk GIST patients who underwent curative resection as initial treatment at four centers from 2001 to 2015. RESULTS: Multivariate analysis revealed that only Ki-67 labeling index (LI) and mitotic index were independent prognostic factors of overall survival (OS). For the two tumor-related pathological factors, Ki-67 LI > 7% and mitotic index ≥ 7/50 high power fields were allocated 1 point each. The total score was defined as the Pathological Prognostic Score (PPS). When Ki-67 LI and mitotic index were replaced by PPS, a multivariate analysis still identified PPS as an independent predictor of OS (HR 2.719; 95% CI 1.309-5.650; P = 0.007). Patients with a PPS of 0, 1, or 2 had a 5-year survival of 91.8, 79.8, and 51.0%, respectively (P = 0.001). Furthermore, an elevated PPS (PPS = 2) was associated with larger tumor size, non-stomach tumor, and open resection (all P < 0.05). CONCLUSION: The PPS independently predicted postoperative survival in high-risk GIST, and it might facilitate the selection of appropriate treatment strategy for these patients.
BACKGROUND: To determine the better risk stratification based on surgical pathology and to assess the clinical outcomes after curative resection with a new scoring system in high risk gastrointestinal stromal tumor (GIST) patients. METHODS: We retrospectively evaluated 506 high-risk GIST patients who underwent curative resection as initial treatment at four centers from 2001 to 2015. RESULTS: Multivariate analysis revealed that only Ki-67 labeling index (LI) and mitotic index were independent prognostic factors of overall survival (OS). For the two tumor-related pathological factors, Ki-67 LI > 7% and mitotic index ≥ 7/50 high power fields were allocated 1 point each. The total score was defined as the Pathological Prognostic Score (PPS). When Ki-67 LI and mitotic index were replaced by PPS, a multivariate analysis still identified PPS as an independent predictor of OS (HR 2.719; 95% CI 1.309-5.650; P = 0.007). Patients with a PPS of 0, 1, or 2 had a 5-year survival of 91.8, 79.8, and 51.0%, respectively (P = 0.001). Furthermore, an elevated PPS (PPS = 2) was associated with larger tumor size, non-stomach tumor, and open resection (all P < 0.05). CONCLUSION: The PPS independently predicted postoperative survival in high-risk GIST, and it might facilitate the selection of appropriate treatment strategy for these patients.
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