Abstract Background: Data on the management and outcome of gastrointestinal stromal tumors (GISTs) in elderlypatients are scant due to their poor representation in clinical trials. Methods:In total, 1379 elderly patients (≥65 years) histologically confirmed GIST between2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database.Results: As a result,surgery alone was the predominant treatment used in both age groups. Patients aged ≥75 years who underwent surgery alone had a median survival of 69 months, chemotherapy alone 51 months, surgery plus chemotherapy 60 months, and no therapy 51 months. While among patients aged 65-74 years, the median OS was not reached (NR), 49, 83, and NR, separately. Besides, C-indexes for the OS nomogram in the training set and validation set were0.771 and 0.761, respectively. Of importance, the predictive model displayed a comparable result to the 8th American Joint Committee on Cancer TNM staging system (p＜0.05), demonstrating improved model discrimination. Conclusions: For elderly patients with GISTs, surgery alone or surgery plus chemotherapy seemed feasible and effective, conferring potential survival benefits even in very elderly patients. Moreover, this simple-to-use nomogram may assist clinicians in treatment decision-making and effectively predict 3- and 5-year survival.