比较改良NIH与AFIP胃肠问质瘤危险度分级标准的多中心回顾性研究

Comparison of modified NIH and AFIP risk-stratification criteria for gastrointestinal stromal tumors： A multicenter retrospective study

目的评估并比较改良NIH标准和AFIP标准对胃肠间质瘤（GIST）危险度分级的应用价值。方法回顾性分析2012年1月至2015年12月在4家医疗中心确诊为原发性GIST且未服用或不规范服用酪氨酸激酶抑制剂的539例患者的临床病理及随访资料，其中南方医科大学南方医院143例，中山大学肿瘤医院138例，广东省人民医院102例，华中科技大学同济医院院附属协和医院156例。分别采用改良NIH及AFIP标准对这组病例进行危险度分级，通过Log-rank检验比较不同危险度患者的总体生存时间和无瘤生存时间，并通过受试者操作特征（ROC）曲线比较两种分级标准预测术后复发的准确度。结果539例GIST患者中男性283例，女性256例，年龄（56.5 ± 12.5）岁；390例（72.4%）肿瘤位于胃；178例（33.0%）肿瘤直径〉 5 cm；164例（30.4%）肿瘤核分裂数〉 5/50高倍镜视野。随访时间（37.5 ± 13.6）月，按改良NIH标准，极低危、低危、中危和高危患者的平均总体生存时间分别为52.0、57.0、56.9和53.6月，差异有统计学意义（P= 0.002）；平均无瘤生存时间分别为56.0、58.1、58.2和51.2月，差异也有统计学意义（P= 0.000）。按AFIP标准，极低危、低危、中危和高危患者的平均总体生存时间分别为54.1、57.8、55.5和52.0月，差异有统计学意义（P= 0.015）；平均无瘤生存时间分别为57.3、56.6、54.9和50.4月，差异也有统计学意义（P= 0.000）。预测术后复发风险时，AFIP分级标准较改良NIH分级标准的ROC曲线具更大的曲线下面积（0.689比0.641，P 〈 0.05）。结论相比改良NIH分级标准，AFIP分级标准更能准确地预测GIST患者的术后复发风险。

ObjectiveTo evaluate and compare the value of Modified NIH criteria and AFIP criteria for the risk classification of gastrointestinal stromal tumors （GIST） .MethodsClinicopathological and follow-up data of 539 patients diagnosed as primary GIST with or without irregular tyrosine kinase inhibitors in the Nanfang Hospital （n= 143） , Sun Yat-sen University Cancer Center （n= 138） , Guangdong Provincial People′s Hospital （n= 102） and Wuhan Union Hospital （n= 156） from January 2012 to December 2015 were retrospectively analyzed. Recurrence risks of these 539 patients were classified by the modified NIH criteria and AFIP criteria. Overall survival and tumor-free survival of patients with different risks were compared by Log-rank test and the accuracy of the two criteria in predicting postoperative recurrence was compared by receiver operating characteristic （ROC） curves.ResultsOf 539 GIST patients, 283 were male and 256 were female; the age was （56.5 ± 12.5） years old; tumors of 390 cases （72.4%） located in the stomach; tumor diameter of 178 cases （33.0%） was more than 5 cm; nuclear division number of 164 cases （30.4%） was more than 5/50 high magnification. The mean follow-up time was （37.5 ± 13.6） months. According to the modified NIH criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 52.0, 57.0, 56.9 and 53.6 months respectively （P= 0.002） , and the mean tumor-free survival time was 56.0, 58.1, 58.2 and 51.2 months respectively （P= 0.000） . According to the AFIP criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 54.1, 57.8, 55.5 and 52.0 months respectively （P= 0.015） , and the mean tumor-free survival time was 57.3, 56.6, 54.9 and 50.4 months respectively （P= 0.000） . While predicting the risk of postoperative recurrence, the ROC curve of AFIP criteria has a larger area under the curve compared to the curve of the modified NIH criteria （0.689 vs 0.641, P 〈 0.05） .ConclusionCompared with the modified NIH criteria, AFIP criteria predicts the risk postoperative recurrence more accurately in GIST patients.