A New Online Dynamic Nomogram: Construction and Validation of a Predictive Model for Distant Metastasis Risk and Prognosis in Patients with Gastrointestinal Stromal Tumors

Wu, Haotian; Ding, Pingan; Wu, Jiaxiang; Sun, Chenyu; Guo, Honghai; Chen, Shuya; Lowe, Scott; Yang, Peigang; Tian, Yuan; Liu, Yang; Zhao, Qun

doi:10.1007/s11605-023-05706-9

Cited by 9 publications

(4 citation statements)

References 35 publications

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“…However, the risk of small intestinal lesions was not significant compared to intragastric lesions, probably because all GIST-SLM patients were included in this study. Lower OS and CSS in patients with tumor size >10 cm compared to patients with tumor size ≤5 cm has been demonstrated in several studies ( 1 , 15 , 16 ). GIST lymph node metastasis is a rare event, but in the current study, the occurrence of lymph node metastasis tends to portend a poor prognosis, and this effect on survival also correlates with the degree of lymph node burden ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 77%

“…However, the amount of data is small and the baseline data is unbalanced, it lacks representativeness (12)(13)(14). While related studies in the SEER database analyzed the effect of surgical treatment on the prognosis of patients with liver metastatic gastrointestinal mesenchymal stromal tumors, they all included patients with metastases from other sites (15,16). Therefore, it is necessary to find reliable clinical methods to predict the prognosis of patients with GIST-SLM and provide rational interventions to improve it.…”

Section: Introductionmentioning

confidence: 99%

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Effects of surgical management for gastrointestinal stromal tumor patients with liver metastasis on survival outcomes

Liu,

Xia,

et al. 2024

Front. Oncol.

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PurposeTo investigate the effect of surgical resection on survival in gastrointestinal stromal tumors synchronous liver metastasis (GIST-SLM) and to develop clinically usable predictive models for overall survival (OS) and cancer-specific survival (CSS) in patients.MethodsWe identified patients in the SEER database diagnosed with GISTs from 2010 to 2019. We used propensity score matching (PSM) to balance the bias between the Surgery and No surgery groups. Kaplan-Meier(K-M) analysis was used to detect differences in OS and CSS between the two groups. The nomogram to predict 1, 3, and 5-year OS and CSS were developed and evaluated.ResultsAfter PSM, 228 patients were included in this study. There were significant differences in 1, 3, and 5-year OS and CSS between the two groups (OS: 93.5% vs. 84.4%, 73.2% vs. 55.3%, 60.9% vs. 36.9%, P=0.014; CSS: 3.5% vs.86.2%,75.3% vs.57.9%, 62.6% vs. 42.9%, P=0.02). We also found that patients who received surgery combined with targeted therapy had better OS and CSS at 1, 3, and 5 years than those who received surgery only (OS: 96.6% vs.90.9%, 74.9% vs. 56.8%, 61.7% vs. 35.5%, P=0.022; CSS: 96.6% vs. 92.1%, 77.4% vs.59.2%,63.8% vs. 42.0%, P=0.023). The area under the curve (AUC) was 0.774, 0.737, and 0.741 for 1, 3, and 5-year OS, respectively, with 0.782 and 0.742 for 1, 3, and 5-year CSS. In the model, C-index was 0.703 for OS and 0.705 for CSS and showed good consistency.ConclusionSurgical treatment can improve the OS and CSS of patients with GIST-SLM. In addition, the combination with chemotherapy may be more favorable for the long-term survival of patients. Meanwhile, we constructed the nomograms for predicting OS and CSS at 1, 3, and 5-year, and validated them internally. Our model can contribute to clinical management and treatment strategy optimization.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Effects of surgical management for gastrointestinal stromal tumor patients with liver metastasis on survival outcomes

Liu,

Xia,

et al. 2024

Front. Oncol.

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“…27 In addition, another recent SEER analysis culminated in the development of an accurate nomogram predictive of distant GIST metastases, controlling for sex, primary site, grade, n stage, tumor size, and mitotic count. 28 In non-malignant cases, R1 surgical margins have not been associated with a lower overall survival; however, complete surgical resection (R0) is ideal. 29 Minimally invasive surgery for small lesions (<5 cm) has been proven efficacious, [30][31][32] while newer methods of resection such as laparoscopic and endoscopic cooperative surgery have been proven efficacious as well.…”

Section: Non-geriatric (<70)mentioning

confidence: 99%

Comparing gastrointestinal stromal tumor outcomes between geriatric and non‐geriatric patients: A population‐based analysis

Singh,

Chitti,

Aguiar

et al. 2024

World j. surg.

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BackgroundGastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the GI tract. SEER is an extensive cancer database which proves useful in analyzing population trends. This analysis investigated GIST outcomes between geriatric & non‐geriatric patients.MethodsSEER*STAT 8.4.0.1 was used to extract relevant GIST data from 2000 to 2019. Geriatric age was defined as ≥70 years. Variables included age, sex, surgery, cancer‐specific death, and overall survival. Statistical tests included univariate analysis using KM survival estimate (95% confidence interval) to calculate 5‐year survival (5YS). Log‐Rank tests determined statistical significance. Multivariable Cox's PH regression estimated the geriatric hazard death ratio adjusted for sex, stage, and surgery.ResultsThe number of patients included was 13,579, yielding overall 5YS of 68.6% (95% CI 67.7–69.5). Cancer‐specific death was 39.11% in 2000 & 3.33% in 2019. Non‐geriatric & geriatric patient data yielded 5YS of 77.4% (76.4%–78.3%) and 53.3% (51.7%–54.8%) respectively (p < 0.0001). For no surgery/surgery, younger patient data yielded 5YS of 48.7% (45.8%–51.4%) and 83.7% (82.7%–84.7%) respectively (p < 0.0001); geriatric data yielded 5YS of 29.3% (26.5%–32.1%) and 62.8% (60.8%–64.6%) respectively (p < 0.0001). Multivariable analysis yielded a geriatric hazard death of 2.56 (2.42–2.70) (p < 0.0001).ConclusionsCancer‐specific death decreased since 2000, indicating an improvement in survival & treatment methods. Observed lower survival rates overall in the geriatric group. Surgery appeared to enhance survival rates in both groups, suggesting that surgery is an important factor in GIST survival regardless of age. Large prospective studies will help define clinical management for geriatric patients.

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“…However, some researchers have demonstrated that the modified NIH stratification (year 2008) may have some defects. Several methods for a recurrence risk assessment have been proposed, but the clinical utility needs further investigation ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

The prognostic role of gastrointestinal bleeding in patients with a primary gastrointestinal stromal tumor: a long-term follow-up study

Shi,

Chen,

Shou

et al. 2023

J Gastrointest Oncol

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Background Gastrointestinal (GI) bleeding is one of the common symptoms of GI stromal tumor (GIST). Although several studies have highlighted its prognostic role, conclusions have been inconsistent. This study aimed to investigate the prognosis of GIST patients with GI bleeding. Methods Primary GIST patients who underwent complete resection and did not receive adjuvant imatinib therapy from January 2003 to December 2008 were reviewed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and multivariate analysis was performed using the Cox proportional hazard model. Propensity score matching (PSM) was conducted to reduce confounders. A systematic review of the published articles in the PubMed, Embase, Cochrane Collaboration, and Medline databases was also conducted, and the inclusion criteria were determined using PICOS (patients, intervention, comparison, outcomes, and study design) principles. Results In total, 84 patients presenting with GI bleeding and 90 patients without GI bleeding were enrolled in this study. The median time of follow-up was 140 months (range, 10–196 months), and 38 patients developed tumor recurrence/metastasis. For all patients, the multivariate analysis indicated that tumor location [hazard ratio (HR) =3.48, 95% confidence interval (CI): 1.78–6.82, P<0.001], tumor size (HR =1.91, 95% CI: 1.05–3.47, P=0.035), mitotic index (MI; HR =5.69, 95% CI: 2.77–11.67, P<0.001), and age (HR =2.68, 95% CI: 1.49–4.82, P=0.001) were the independent prognostic factors for poor RFS. However, GI bleeding was not associated with RFS (HR =1.21, 95% CI: 0.68–2.14, P=0.518). After PSM, 45 patients from each group were included, and it was found that GI bleeding was still not the independent prognostic factor (HR =1.23, 95% CI: 0.51–2.97, P=0.642). Moreover, the pooled results of our study and six previously reported studies showed that GI bleeding was not the independent prognostic factor (HR =1.45, 95% CI: 0.73–2.86, P=0.287). Conclusions In this study, tumor location, tumor size, MI, and age were independent prognostic factors in primary GIST patients who underwent radical resection. However, GI bleeding was not associated with worse RFS.

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A New Online Dynamic Nomogram: Construction and Validation of a Predictive Model for Distant Metastasis Risk and Prognosis in Patients with Gastrointestinal Stromal Tumors

Cited by 9 publications

References 35 publications

Effects of surgical management for gastrointestinal stromal tumor patients with liver metastasis on survival outcomes

Effects of surgical management for gastrointestinal stromal tumor patients with liver metastasis on survival outcomes

Comparing gastrointestinal stromal tumor outcomes between geriatric and non‐geriatric patients: A population‐based analysis

The prognostic role of gastrointestinal bleeding in patients with a primary gastrointestinal stromal tumor: a long-term follow-up study

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