Gold, J. S., Gonen, M., Gutierrez, A., Broto, J. M., Garcia-del-Muro, X., Smyrk, T. C., Maki, R. G., Singer, S., Brennan, M. F., Antonescu, C. R., Donohue, J. H., DeMatteo, R. P. (November 2009) Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol, 10 (11). pp. 1045-52. ISSN 1474-5488 (Electronic)1470-2045 (Linking)
Abstract
BACKGROUND: Adjuvant imatinib mesylate prolongs recurrence-free survival (RFS) after resection of localised primary gastrointestinal stromal tumours (GIST). We aimed to develop a nomogram to predict RFS after surgery in the absence of adjuvant therapy to help guide patient selection for adjuvant imatinib therapy. METHODS: A nomogram to predict RFS based on tumour size (cm), location (stomach, small intestine, colon/rectum, or other), and mitotic index (<5 or > or =5 mitoses per 50 high-power fields) was developed from 127 patients treated at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY, USA. The nomogram was tested in patients from the Spanish Group for Research on Sarcomas (GEIS; n=212) and the Mayo Clinic, Rochester, MN, USA (Mayo; n=148). The nomogram was assessed by calculating concordance probabilities and testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with those of three commonly used staging systems. FINDINGS: The nomogram had a concordance probability of 0.78 (SE 0.02) in the MSKCC dataset, and 0.76 (0.03) and 0.80 (0.02) in the validation cohorts. Nomogram predictions were well calibrated. Inclusion of tyrosine kinase mutation status in the nomogram did not improve its discriminatory ability. Concordance probabilities of the nomogram were better than those of the two NIH staging systems (0.76 [0.03] vs 0.70 [0.04, p=0.04] and 0.66 [0.04, p=0.01] in the GEIS validation cohort; 0.80 [0.02] vs 0.74 [0.02, p=0.04] and 0.78 [0.02, p=0.05] in the Mayo cohort) and similar to those of the AFIP-Miettinen staging system (0.76 [0.03] vs 0.73 [0.004, p=0.28] in the GEIS cohort; 0.80 [0.02] vs 0.76 [0.003, p=0.09] in the Mayo cohort). Nomogram predictions of RFS seemed better calibrated than predictions made with the AFIP-Miettinen system. INTERPRETATION: The nomogram accurately predicts RFS after resection of localised primary GIST and could be used to select patients for adjuvant imatinib therapy.
| Item Type: | Paper |
|---|---|
| Uncontrolled Keywords: | Adolescent Adult Aged Aged, 80 and over Antineoplastic Agents/*therapeutic use Benzamides Chemotherapy, Adjuvant Child *Digestive System Surgical Procedures Disease-Free Survival Female Gastrointestinal Stromal Tumors/drug therapy/mortality/secondary/*surgery Humans Imatinib Mesylate Kaplan-Meier Estimate Male Middle Aged Mitotic Index Neoplasm Invasiveness Neoplasm Staging *Nomograms *Patient Selection Piperazines/*therapeutic use Predictive Value of Tests Proportional Hazards Models Protein Kinase Inhibitors/*therapeutic use Pyrimidines/*therapeutic use Registries Reproducibility of Results Retrospective Studies Risk Assessment Spain/epidemiology Time Factors Treatment Outcome United States/epidemiology Young Adult |
| Subjects: | diseases & disorders > cancer > cancer types > gastrointestinal stromal tumors diseases & disorders > cancer > prognosis |
| CSHL Authors: | |
| Communities: | CSHL labs > Maki lab |
| Depositing User: | Matt Covey |
| Date: | November 2009 |
| Date Deposited: | 25 Oct 2016 20:33 |
| Last Modified: | 25 Oct 2016 20:33 |
| PMCID: | PMC3175638 |
| Related URLs: | |
| URI: | https://repository.cshl.edu/id/eprint/33698 |
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