Development of a prognostic prediction model for tumor recurrence or progression in gastrointestinal stromal tumors: integrating inflammatory blood indices with 5 mm2 versus 50 high-power field mitotic counts
Mitotic counting in 50 HPF overestimated risk classification in certain cases.
The study evaluated how two mitotic counting methods (5 mm² versus 50 high‑power fields) influence risk classification and developed a prognostic model that combines inflammatory biomarkers (SII, PLR, MLR) with clinicopathological factors in patients with gastrointestinal stromal tumors. Retrospective analysis of 150 cases resected between 2009 and 2021 demonstrated that counting in 50 HPF overestimated risk in 14.2% of cases. A model incorporating tumor size, location, rupture, mitotic count in 5 mm² and SII achieved a time‑dependent AUC of 0.939 (95% CI 0.894‑0.983) for 5‑year disease‑free survival, outperforming previous models of AFIP, modified NIH, and AJCC. The study concluded that standardized 5 mm² mitotic counting combined with systemic immune‑inflammation index improves prognostic accuracy.
Over‑classification of risk can lead to overtreatment with adjuvant therapy, exposing patients to unnecessary drug toxicity and cost.
Evidence level: Állatkísérletes. Állatmodellben vizsgálták.
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