Establishment and Verification of Synchronous Metastatic Nomogram for Gastrointestinal Stromal Tumors (GISTs): A Population-Based Analysis

Abstract

Aim. Assess the risk of synchronous metastasis and establish a nomogram in patients with GISTs. Methods. Surveillance, Epidemiology and End Results database (2004-2014) was accessed. With the logistic regression model as the basis, a nomogram was constructed. Results. 7,256 target patients were contained in our study. The nomogram discrimination for mGIST prediction revealed that tumor size contributed most to synchronous metastasis, followed by lymph nodes, extension, pathologic grade, tumor location, and mitotic count. C-index values of predictions were 0.821 (95% CI, 0.805-0.836) and 0.815 (95% CI, 0.800-0.831), and Brier score were 0.109 and 0.112 in training and validation group, respectively. The value of area under the ROCs were 0.813 (p<0.001) in the primary cohort and 0.819 (p<0.001) in the validation cohort. Through the calibration curves (as seen in the figures), nomogram prediction proved to have excellent agreement with actual metastatic diseases. Conclusion. A new nomogram was created that can evaluate synchronous metastatic diseases in patients with GISTs.

Establishment and Verification of a Nomogram for Predicting Survival in Patients with Small Intestinal Gastrointestinal Stromal Tumors

“…Consistent with these reports, our study also found that age presented the highest risk score of all the prognostic factors in the nomograms. Several studies indicated that tumor grade was an independent factor for prediction of survival in GISTs [24,27,31]. Song et al [36] developed a nomogram in GIST patients and showed the magnitude of poor prognosis as tumor grade changed from well-to poorly differentiated, which was in line with our study.…”

“…It is reported that the prognosis of GISTs in the small intestine was worse than that in the stomach [28][29][30]. Li et al [31] aimed to assess the risk of synchronous metastasis in patients with GISTs and showed that tumors located in the small intestine held the highest metastatic risk. The proposed OS nomogram in our study included several independent prognostic factors -age, surgery, imatinib treatment, and AJCC stage, while the CSS nomogram incorporated age, surgery, tumor grade, and AJCC stage, which were all identified by applying both forward and backward stepwise selection methods in a Cox regression model.…”