TY - JOUR
T1 - Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour
T2 - a retrospective analysis
AU - Gold, Jason S.
AU - Gönen, Mithat
AU - Gutiérrez, Antonio
AU - Broto, Javier Martín
AU - García-del-Muro, Xavier
AU - Smyrk, Thomas C.
AU - Maki, Robert G.
AU - Singer, Samuel
AU - Brennan, Murray F.
AU - Antonescu, Cristina R.
AU - Donohue, John H.
AU - DeMatteo, Ronald P.
N1 - Funding Information:
We thank Imran Hassan and Y Nancy You for their contribution to the Mayo Clinic patient series. This work was supported by Public Health Service grant CA102613 (RPD) and P01 CA47179 (SS) from the National Cancer Institute, and a clinical investigator award from the Society of Surgical Oncology (RPD).
PY - 2009/11
Y1 - 2009/11
N2 - 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 ≥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. Funding: National Cancer Institute, Bethesda, MD, USA.
AB - 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 ≥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. Funding: National Cancer Institute, Bethesda, MD, USA.
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U2 - 10.1016/S1470-2045(09)70242-6
DO - 10.1016/S1470-2045(09)70242-6
M3 - Article
C2 - 19793678
AN - SCOPUS:71449088757
SN - 1470-2045
VL - 10
SP - 1045
EP - 1052
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 11
ER -