Abstract
BackgroundThe prognosis of patients with gastrointestinal stromal tumors (GISTs) is generally evaluated at the time of diagnosis but does not reflect the survival dynamics of patients in the future. Therefore, the purpose of this article was to evaluate the conditional survival (CS) of Chinese patients with GISTs after radical resection.MethodsThis retrospective study included 451 patients who underwent radical surgery for GISTs. A Cox proportional hazard model was used to evaluate the prognostic factors of disease-free survival (DFS). The 3-year conditional DFS (CDFS3) of patients who survived for x years was expressed as CDFS3=DFS(x + 3)/DFS(x).ResultsThe traditional 3-year DFS rate decreased gradually from 94.0% at 3 years to 77.3% at 7 years, while the CDFS3 rate increased from 94.0 to 95.2% over the survival time of the patients. In addition, classic clinicopathological prognostic factors had different effects on CDFS3, with changes observed in survival time, but these effects were only slight or moderate (|d|<0.5). Although multivariate analysis showed that age, sex, mitotic index and tumor rupture were independent risk factors for DFS at baseline, all adverse prognostic factors, except for the mitotic index, lost their predictive significance at 5 years after operation. When the Modified NIH criteria were included, the risk staging was found to be an independent risk factor for recurrence or death. Time-dependent Cox regression analysis showed that the modified NIH criteria independently affected the recurrence or death of GIST patients within 2 years after operation.ConclusionCS provides detailed dynamic survival information about Chinese patients with primary resected GISTs. The mitotic index is of great clinical significance for the monitoring and follow-up of patient populations with a high risk of tumor recurrence or death until 5 years after surgery.
Highlights
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, accounting for 18% of all sarcomas [1,2,3]
Even in patients initially diagnosed with a poor prognosis, the survival rate is greatly improved after a period of survival [10,11,12] the survival probability of patients cannot be accurately predicted with postoperative data, as these data can only aid in evaluating the prognosis of patients in the short term
We found that the estimated CDFS exceeded the traditional disease-free survival (DFS) estimate, and this performance was more pronounced among patients with gastrointestinal stromal tumors (GISTs) as cumulative survival time increased
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, accounting for 18% of all sarcomas [1,2,3]. Complete surgical resection and postoperative adjuvant therapy with imatinib are still the only treatments for GIST patients. The survival data of patients with GISTs are mostly evaluated from the date of diagnosis or the date of operation [7,8,9]. These studies are too dependent on static pathological factors after surgery to estimate the prognosis of patients and cannot reflect long-term survival information. The prognosis of patients with gastrointestinal stromal tumors (GISTs) is generally evaluated at the time of diagnosis but does not reflect the survival dynamics of patients in the future. The purpose of this article was to evaluate the conditional survival (CS) of Chinese patients with GISTs after radical resection
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