Systematic review of current prognostication systems for primary gastrointestinal stromal tumors

Khoo, Chun Yuet; Chai, Xun; Quek, Richard; Teo, Melissa Ching Ching; Goh, Brian K. P.

doi:10.1016/j.ejso.2017.12.006

Cited by 37 publications

(28 citation statements)

References 54 publications

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“…In recent years, Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram has been worldwide used to generate the probability of a clinical event through a complex computational formula [18,19]. With the aid of nomogram, clinicians can assess the risk of the clinical event and then design individual treatment plans, determine the use of adjuvant therapy, optimize aspects of therapies and consider appropriate patient counselling [20]. Considering the important role of LIM in the prognosis of GIST, the study presented in evaluating patients with GIST and discovering patients with high-risk scores in liver metastasis by the use of nomogram.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study

et al. 2020

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Background Liver metastasis (LIM) of gastrointestinal stromal tumor (GIST) is associated with poor prognosis. The present study aimed at developing and validating nomogram to predict LIM in patients with GIST, thus helping clinical diagnosis and treatment. Methods The data of GIST patients derived from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016, which were then screened by univariate and multivariate logistic regression for the construction of LIM nomogram. The model discrimination of LIM nomogram was evaluated by concordance index (C-index) and calibration plots, while the predictive accuracy and clinical values were measured by decision curve analysis (DCA) and clinical impact plot. Furthermore, we validated predictive nomogram in the internal testing set. Results A total of 3797 patients were enrolled and divided randomly into training and validating groups in a 3-to-1 ratio. After logistic regression, the significant variables were sex, tumor location, tumor size, N stage and mitotic rate. The calibration curves showed the perfect agreement between nomogram predictions and actual observations, while the DCA and clinical impact plot showed the clinical utility of LIM nomogram. C-index of the nomogram was 0.812. What’s more, receiver operating characteristic curves (ROC) also showed good discrimination and calibration in the training set (AUC = 0.794, 95% CI 0.778–0.808) and the testing set (AUC = 0.775, 95% CI 0.748–0.802). Conclusion The nomogram for patients with GIST can effectively predict the individualized risk of liver metastasis and provide insightful information to clinicians to optimize therapeutic regimens.

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Section: Introductionmentioning

confidence: 99%

A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study

et al. 2020

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“…There were numerous prognostication systems for the risk stratification of GISTs and many studies investigated the most accurate system (14) . The parameters vary in these systems.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of radiological findings of gastrointestinal stromal tumors in the prediction of high-risk potential for malignancy: comparison of the NIH and AFIP criteria

Sarıoğlu¹,

Oncel²,

Sarıoğlu³

et al. 2019

TERH

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were evaluated retrospectively. Twenty-seven patients were excluded from the study because their preoperative computed tomography results could not be reached. We evaluated preoperative computed tomography examinations of 23 patients included in the study with gastrointestinal stromal tumors according to size, contour, central hypoattenuation, homogeneity, contrast enhancement, growth pattern, mesenteric heterogeneity, local invasion to surrounding tissues, cavitation, concomitant presence of lymphadenopathy larger than 1 cm, fluid collection and metastasis. Radiological findings were compared with histopathologic findings, and the effectiveness of radiological findings on the prediction of malignancy potential was evaluated according to the National Institutes of Health and the Armed Forces Institute of Pathology criteria. Univariate and multivariate logistic regression analyses were used and p<0.05 was accepted as the level of statistical significance. Results: Tumor size (p=0.023) and central hypodensity (p=0.036) were found to be statistically significant for risk stratification according to the National Institutes of Health criteria. Contour irregularity (p=0.036, p=0.026) and mesenteric heterogeneity (p=0.021, p=0.005) were found to be statistically significant in decreasing importance in the evaluation of high risk potential according to the National Institutes of Health and the Armed Forces Institute of Pathology criteria, respectively. Conclusion: Contour irregularity and mesenteric heterogeneity may be useful to predict the high risk potential according to the both criteria. Tumor size and central hypodensity may provide risk stratification according to the NIH criteria. ÖZAmaç: Çalışmamızın amacı gastrointestinal stromal tümörlerin radyolojik bulgularının malignite potansiyelini öngörmedeki etkinliğinin National Institutes of Health ve Armed Forces Institute of Pathology kritlerine göre araştırılmasıdır. Yöntem: Çalışmamızda Ocak 2010-Ocak 2016 tarihleri arasında patolojik olarak gastrointestinal stromal tümör tanısı almış 50 hasta rerospektif olarak incelenmiştir. Yirmi yedi hasta preoperatif bilgisayarlı tomografi tetkiklerine ulaşılamadığından çalışma dışı bırakılmıştır. Çalışmaya dahil olan 23 hastanın preoperatif bilgisayarlı tomografi tetkiklerinde tümörler boyut, kontur özellikleri, homojenite, kontrastla boyanma şekli, santral hipoatenüasyon varlığı, büyüme paterni, mezenterik heterojenite, çevre dokulara invazyon, kavitasyon, eşlik eden batın içi serbest sıvı, eşlik eden karaciğer metastazı ve 1 cm'den büyük lenf nodunun varlığı açısından değerlendirilmiştir. Radyolojik bulgular histopatolojik bulgular ile kıyaslanmış ve radyolojik bulguların malignite potansiyelini öngörmedeki etkinlikleri araştırılmıştır. Tek değişkenli ve çok değişkenli lojistik regresyon analizleri kullanılmış ve p<0,05 olması anlamlı kabul edilmiştir. Bulgular: Yirmi üç hasta ile yaptığımız çalışmamızda tümör boyutu (p=0,023) ve santral hipodansite varlığı (p=0,036) National Institutes of Health kriterlerine göre risk gr...

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“…Imatinib, targeting KIT and PDGFRA , has become the standard first-line adjuvant drug for GISTs, thus improving the prognosis of intermediate-high risk GIST patients [ 31 , 32 ]. For these GIST patients, imatinib can improve the 3-year recurrence-free survival rate [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Potential of PI3K/AKT/mTOR Pathway in Gastrointestinal Stromal Tumors: Rationale and Progress

Duan

Haybaeck

Yang

2020

Cancers

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Gastrointestinal stromal tumor (GIST) originates from interstitial cells of Cajal (ICCs) in the myenteric plexus of the gastrointestinal tract. Most GISTs arise due to mutations of KIT and PDGFRA gene activation, encoding the receptor tyrosine kinase (RTK). The clinical use of the RTK inhibitor imatinib has significantly improved the management of GIST patients; however, imatinib resistance remains a challenge. The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway is a critical survival pathway for cell proliferation, apoptosis, autophagy and translation in neoplasms. Constitutive autophosphorylation of RTKs has an impact on the activation of the PI3K/AKT/mTOR pathway. In several preclinical and early-stage clinical trials PI3K/AKT/mTOR signaling inhibition has been considered as a promising targeted therapy strategy for GISTs. Various inhibitory drugs targeting different parts of the PI3K/AKT/mTOR pathway are currently being investigated in phase I and phase II clinical trials. This review highlights the progress for PI3K/AKT/mTOR-dependent mechanisms in GISTs, and explores the relationship between mTOR downstream signals, in particular, eukaryotic initiation factors (eIFs) and the development of GISTs, which may be instrumental for identifying novel therapeutic targets.

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Systematic review of current prognostication systems for primary gastrointestinal stromal tumors

Cited by 37 publications

References 54 publications

A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study

A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study

Effectiveness of radiological findings of gastrointestinal stromal tumors in the prediction of high-risk potential for malignancy: comparison of the NIH and AFIP criteria

Therapeutic Potential of PI3K/AKT/mTOR Pathway in Gastrointestinal Stromal Tumors: Rationale and Progress

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