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中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 438 -441. doi: 10.3877/cma.j.issn.1674-3946.2025.04.023.

论著

基于随机生存森林的胃肠道间质瘤无复发生存期预测模型研究
袁强1,2, 向文瑞3, 吕远1,2, 闫璋哲1,2, 朱含放1,2, 陈光1,2, 孙亮1,2, 陈纲1,2,(), 赵锁4,()   
  1. 1. 100700 北京 中国人民解放军总医院第七医学中心普通外科
    2. 100853 北京 中国人民解放军总医院第一医学中心普通外科医学部
    3. 529200 广东江门 中国人民解放军总医院第九一〇二四部队
    4. 264000 山东烟台,联勤保障部队第九七〇医院肝胆甲乳外科
  • 收稿日期:2025-03-21 出版日期:2025-08-26
  • 通信作者: 陈纲, 赵锁

Study on prediction model of recurrence-free survival for gastrointestinal stromal tumors based on random survival forest

Qiang Yuan1,2, Wenrui Xiang3, Yuan Lv1,2, Zhangzhe Yan1,2, Hanfang Zhu1,2, Guang Chen1,2, Liang Sun1,2, Gang Chen1,2,(), Suo Zhao4,()   

  1. 1. Department of Gerneral Surgery, the 7th Medical Center of Chinese PLA General Hospital, Beijing 100700,China
    2. Medical Department of Gerneral Surgery, the 1th Medical Center of PLA General Hospital, Beijing 100853,China
    3. The 91024th Force of China’s People’s Liberation Army, Jiangmen Guangdong Province 529200,China
    4. Department of Hepatobiliary, Thyroid and Breast Surgery, the 970th Hospital of the Joint Logistics Support Force, Yantai Shandong
  • Received:2025-03-21 Published:2025-08-26
  • Corresponding author: Gang Chen, Suo Zhao
引用本文:

袁强, 向文瑞, 吕远, 闫璋哲, 朱含放, 陈光, 孙亮, 陈纲, 赵锁. 基于随机生存森林的胃肠道间质瘤无复发生存期预测模型研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 438-441.

Qiang Yuan, Wenrui Xiang, Yuan Lv, Zhangzhe Yan, Hanfang Zhu, Guang Chen, Liang Sun, Gang Chen, Suo Zhao. Study on prediction model of recurrence-free survival for gastrointestinal stromal tumors based on random survival forest[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 438-441.

目的

回顾性分析胃肠道间质瘤(GIST)患者预后相关临床病理因素,构建适用于不同治疗模式的动态风险评估模型,为优化术后辅助治疗决策提供循证依据。

方法

纳入2009年5月至2019年6月确诊的250例GIST患者,采用单因素Kaplan-Meier生存分析(Log-Rank检验)初筛与无复发生存期(RFS)相关的临床病理因素,基于随机生存森林(RSF)算法构建预后预测模型并进行危险分层。

结果

在未接受术后辅助治疗组中,男性、肠道原发部位、肿瘤最大径>5cm、核分裂象计数>5/50HPF、Ki-67增殖指数升高、上皮样细胞型以及KIT基因外显子11的557/558/559密码子缺失突变与术后复发显著相关;而在接受伊马替尼辅助治疗组中,仅肠道原发部位、核分裂象计数>5/50HPF、Ki-67增殖指数升高及细胞形态学特征与复发风险相关。上皮样细胞型在伊马替尼治疗组中生存结局反而优于其他细胞类型,提示该组织学亚型可能对酪氨酸激酶抑制剂治疗具有潜在敏感性。

结论

本研究构建的随机生存森林动态预测模型表现出良好的效能,在伊马替尼治疗组中弥补了NIH分级的不足,此外,上皮样细胞型的双刃剑特性为组织学分型指导精准治疗提供了新依据。

Objective

To retrospectively analyze clinical and pathological factors related to the prognosis of gastrointestinal stromal tumor (GIST) patients, construct a dynamic risk assessment model for different treatment modalities, and provide evidence-based support for optimizing postoperative adjuvant treatment decisions.

Methods

A total of 250 GIST patients diagnosed between May 2009 and June 2019 were included. Univariate Kaplan-Meier survival analysis (Log-Rank test) was used to screen factors related to recurrence-free survival (RFS), and a prognostic prediction model and risk stratification were constructed based on the random survival forest (RSF) algorithm.

Results

In the group not receiving postoperative adjuvant therapy, male sex, intestinal origin, tumor size > 5cm, mitotic count > 5/50HPF, elevated Ki-67 proliferation index, epithelioid cell type, and KIT exon 11 codon 557/558/559 deletion mutation were significantly associated with recurrence. In the imatinib adjuvant therapy group, only intestinal origin, mitotic count > 5/50HPF,elevated Ki-67 proliferation index, and cell morphology were related to recurrence risk. Epithelioid cell type had a better survival outcome in the imatinib group, suggesting potential sensitivity to tyrosine kinase inhibitor therapy.

Conclusion

The constructed RSF dynamic prediction model has good performance, compensating for the NIH classification deficiency in the imatinib group. The dual characteristics of epithelioid cell type offer new evidence for histological subtype-guided precise treatment.

表1 GIST患者的基线特征
图1 两组GIST患者Kaplan-Meier生存分析
图2 两组随机生存森林模型的错误率曲线、变量重要性图及ROC曲线
图3 两组NIH重新分组后构建的Kaplan-Meier生存曲线和依据随机生存森林预测模型分组后构建的Kaplan-Meier生存曲线
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