title: Validation of the MSKCC Gastrointestinal Stromal Tumor Nomogram and Comparison with Other Prognostication Systems: Single-Institution Experience with 289 Patients.
abstract: OBJECTIVE
  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.
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors: Aik-Yong
authors: AY
authors: Chok
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore. bsgkp@hotmail.com.|Duke-NUS Graduate Medical School, Singapore, Singapore. bsgkp@hotmail.com.
authors: Brian K P
authors: BK
authors: Goh
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors: Ye-Xin
authors: YX
authors: Koh
authors: Duke-NUS Graduate Medical School, Singapore, Singapore.
authors: Weng-Kit
authors: WK
authors: Lye
authors: Duke-NUS Graduate Medical School, Singapore, Singapore.
authors: John C
authors: JC
authors: Allen
authors: Division of Medical Oncology, National Cancer Centre, Singapore, Singapore.
authors: Richard
authors: R
authors: Quek
authors: Division of Surgical Oncology, National Cancer Centre, Singapore, Singapore.
authors: Melissa C C
authors: MC
authors: Teo
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Graduate Medical School, Singapore, Singapore.
authors: Pierce K H
authors: PK
authors: Chow
authors: Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore.
authors: Hock-Soo
authors: HS
authors: Ong
authors: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors: Alexander Y F
authors: AY
authors: Chung
authors: Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore.
authors: Wai-Keong
authors: WK
authors: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D044466:Asian People; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D049451:Nomograms; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications; D047368:Tumor Burden