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Validation of the MSKCC Gastrointestinal Stromal Tumor Nomogram and Comparison with Other Prognostication Systems: Single-Institution Experience with 289 Patients

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To validate the Memorial Sloan Kettering Cancer Center (MSKCC) prognostic nomogram in a single-institution cohort of patients with gastrointestinal stromal tumors (GISTs), and to compare its predictive accuracy against other established risk classification systems, including the National Institutes of Health (NIH), Armed Forces Institute of Pathology (AFIP), and Joensuu criteria.

Methods

We retrospectively reviewed 289 patients who underwent surgical resection for primary localized GISTs without adjuvant imatinib therapy and compared the actuarial recurrence-free survival (RFS) with the predicted RFS.

Results

Tumors >5 cm in size, with high mitotic index, and which had ruptured were significantly associated with recurrent disease. The 2-year RFS was 77.2 % [95 % confidence interval (CI) 71.6–81.8], and the 5-year RFS was 67.9 % (95 % CI 61.7–73.4). The concordance probability of the nomogram of 2-year RFS was 0.71 (SE 0.02), and 5-year RFS was 0.71 (SE 0.19). The 2-year and 5-year MSKCC nomogram probability calculations and the AFIP criteria gave a better estimation of RFS compared to the NIH (p < 0.001) and Joensuu (p < 0.001) criteria. There was no significant difference between the predictive accuracy of the nomogram compared to the AFIP criteria.

Conclusions

The MSKCC nomogram slightly underestimated the probability of RFS after surgical resection of GISTs. It was associated with a significantly better predictive accuracy compared to the NIH and Joensuu. This study suggests that there is a wider than expected prognostic divergence between gastric GISTs versus GISTs arising from the small intestine.

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References

  1. Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.

    Article  CAS  PubMed  Google Scholar 

  2. Reith JD, Goldblum JR, Lyles RH, Weiss SW. Extragastrointestinal (soft tissue) stromal tumors: an analysis of 48 cases with emphasis on histologic predictors of outcome. Mod Pathol. 2000;13:577–85.

    Article  CAS  PubMed  Google Scholar 

  3. Goh BK, Chow PK, Kesavan SM, Yap WM, Chung YF, Wong WK. A single-institution experience with eight CD117-positive primary extragastrointestinal stromal tumors: critical appraisal and a comparison with their gastrointestinal counterparts. J Gastrointest Surg. 2009;13:1094–8.

    Article  PubMed  Google Scholar 

  4. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23:70–83.

    Article  PubMed  Google Scholar 

  5. Huang HY, Li CF, Huang WW, et al. A modification of NIH consensus criteria to better distinguish the highly lethal subset of primary localized gastrointestinal stromal tumors: a subdivision of the original high-risk group on the basis of outcome. Surgery. 2007;141:748–56.

    Article  PubMed  Google Scholar 

  6. Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY; ESMO Guidelines Working Group. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009;20(Suppl 4):64–7.

    PubMed  Google Scholar 

  7. Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010;8(Suppl 2):S1–41.

    PubMed Central  CAS  PubMed  Google Scholar 

  8. Blackstein ME, Blay JY, Corless C, et al; Canadian Advisory Committee on GIST. Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol. 2006;20:157–63.

    PubMed Central  PubMed  Google Scholar 

  9. Goh BK, Chow PK, Kesavan SM, Yap WM, Chung YF, Wong WK. Outcome after curative resection of large (> or = 10 cm) gastric gastrointestinal stromal tumors: how frequent is adjacent organ involvement and is concomitant distal pancreatectomy necessary? J Gastrointest Surg. 2010;14:607–13.

    Article  PubMed  Google Scholar 

  10. Goh BK, Chow PK, Kesavan S, Yap WM, Wong WK. Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: is limited resection appropriate? J Surg Oncol. 2008;97:388–91.

    Article  PubMed  Google Scholar 

  11. Chok AY, Koh YX, Ow MY, Allen JC Jr, Goh BK. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol. 2014;21:3429–38.

  12. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Koh YX, Chok AY, Zheng HL, et al. A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol. 2013;20:3549–60.

    Article  PubMed  Google Scholar 

  14. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459–65.

    Article  PubMed  Google Scholar 

  15. Rutkowski P, Nowecki ZI, Michej W, et al. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor. Ann Surg Oncol. 2007;14:2018–27.

    Article  PubMed  Google Scholar 

  16. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer. 2005;103:821–9.

    Article  PubMed  Google Scholar 

  17. Ahmed I, Welch NT, Parsons SL. Gastrointestinal stromal tumours (GIST)—17 years’ experience from Mid Trent Region (United Kingdom). Eur J Surg Oncol. 2008;34:445–9.

    Article  CAS  PubMed  Google Scholar 

  18. Hassan I, You YN, Shyyan R, et al. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol. 2008;15:52–9.

    Article  PubMed  Google Scholar 

  19. Goh BK, Chow PK, Yap WM, et al. Which is the optimal risk stratification system for surgically treated localized primary GIST? Comparison of three contemporary prognostic criteria in 171 tumors and a proposal for a modified Armed Forces Institute of Pathology risk criteria. Ann Surg Oncol. 2008;15:2153–63.

    Article  PubMed  Google Scholar 

  20. Casali PG, Blay JY; ESMO/CONTICANET/EUROBONET Consensus Panel of Experts. Gastrointestinal stromal tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v98–102.

    Article  PubMed  Google Scholar 

  21. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39:1411–9.

    Article  PubMed  Google Scholar 

  22. Woodall CE 3rd, Brock GN, Fan J, et al. An evaluation of 2537 gastrointestinal stromal tumors for a proposed clinical staging system. Arch Surg. 2009;144:670–8.

    Article  PubMed  Google Scholar 

  23. Gold JS, Gönen M, Gutiérrez A, et al. 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. 2009;10:1045–52.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543–6.

    Article  PubMed  Google Scholar 

  25. Dematteo RP, Ballman KV, Antonescu CR, et al; American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised,double-blind, placebo-controlled trial. Lancet. 2009;373(9669):1097–104.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Tanimine N, Tanabe K, Suzuki T, Tokumoto N, Ohdan H. Prognostic criteria in patients with gastrointestinal stromal tumors: a single center experience retrospective analysis. World J Surg Oncol. 2012;10:43.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Cohen MH, Cortazar P, Justice R, Pazdur R. Approval summary: imatinib mesylate in the adjuvant treatment of malignant gastrointestinal stromal tumors. Oncologist. 2010;15:300–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Joensuu H, Eriksson M, Sundby Hall K, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307:1265–72.

    Article  CAS  PubMed  Google Scholar 

  29. Patel S. Navigating risk stratification systems for the management of patients with GIST. Ann Surg Oncol. 2011;18:1698–704.

    Article  PubMed  Google Scholar 

  30. Joensuu H. Predicting recurrence-free survival after surgery for GIST. Lancet Oncol. 2009;10:1025.

    Article  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore

    Aik-Yong Chok MBBS, MRCS, Brian K. P. Goh MBBS, MMed, MSc, FRCS, Ye-Xin Koh MBBS, MRCS, Pierce K. H. Chow MBBS, FRCS, PhD & Alexander Y. F. Chung MBBS, FRCS

  2. Duke-NUS Graduate Medical School, Singapore, Singapore

    Brian K. P. Goh MBBS, MMed, MSc, FRCS, Weng-Kit Lye MSc, John C. Allen Jr. PhD & Pierce K. H. Chow MBBS, FRCS, PhD

  3. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore

    Richard Quek MBBS, MRCP

  4. Division of Surgical Oncology, National Cancer Centre, Singapore, Singapore

    Melissa C. C. Teo MBBS, MRCS, FRCS

  5. Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore

    Hock-Soo Ong MBBS, FRCS & Wai-Keong Wong MBBS, FRCS

Authors
  1. Aik-Yong Chok MBBS, MRCS
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  2. Brian K. P. Goh MBBS, MMed, MSc, FRCS
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  3. Ye-Xin Koh MBBS, MRCS
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  5. John C. Allen Jr. PhD
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  6. Richard Quek MBBS, MRCP
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  7. Melissa C. C. Teo MBBS, MRCS, FRCS
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  8. Pierce K. H. Chow MBBS, FRCS, PhD
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  10. Alexander Y. F. Chung MBBS, FRCS
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  11. Wai-Keong Wong MBBS, FRCS
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Corresponding author

Correspondence to Brian K. P. Goh MBBS, MMed, MSc, FRCS.

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Chok, AY., Goh, B.K.P., Koh, YX. et al. Validation of the MSKCC Gastrointestinal Stromal Tumor Nomogram and Comparison with Other Prognostication Systems: Single-Institution Experience with 289 Patients. Ann Surg Oncol 22, 3597–3605 (2015). https://doi.org/10.1245/s10434-015-4400-z

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  • DOI: https://doi.org/10.1245/s10434-015-4400-z

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