Xu Pan, Ding Wei, Zheng Feifei, Ruan Tingyan, Liu Jing, Ding Junli, Xu Junying
Oncology Department, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China.
Gastroenterology, Naval Medical Center of PLA, Shanghai, China.
J Gastrointest Oncol. 2024 Feb 29;15(1):112-124. doi: 10.21037/jgo-24-27. Epub 2024 Feb 28.
Gastrointestinal stromal tumor (GIST) is a common mesenchymal tumor of the gastrointestinal system. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT.
Data from the Surveillance Epidemiology, and End Results (SEER) database of 1,213 patients diagnosed with GIST between 2010 and 2019 were dichotomized into a modeling set and a validation set at a 2:1 ratio. For the modeling set, both univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. A nomogram was then constructed based on these determinants. Model efficacy was tested using receiver operating characteristic (ROC) curves, calibration curves, clinical decision curves, and risk stratification analysis in both subsets.
Identified prognostic determinants included age, sex, pathological differentiation level, tumor-node-metastasis (TNM) stage, surgical intervention, radiotherapy, and marital status. The constructed nomogram showed area under the ROC curve (AUC) values of 0.822, 0.793, and 0.779 for 1-, 3-, and 5-year overall survival (OS) in the modeling set, respectively, while in the validation set, the values were 0.796, 0.823, and 0.806, respectively. Calibration plots from both sets confirmed the concordance between predicted and observed survival. Decision curve analysis (DCA) indicated significant clinical utility for the nomogram. Risk stratification of the patient data revealed distinct survival differences between high-risk and low-risk cohorts in both sets (P<0.001).
A novel and potent nomogram for the prognosis of GIST has been introduced. This model's precision offers crucial insights for clinical decisions, yet further external validation remains essential.
胃肠道间质瘤（GIST）是胃肠道系统常见的间叶组织肿瘤。它们起源于位于肌层的 Cajal 间质细胞，其特征是酪氨酸激酶受体 KIT 过度表达。
将 2010 年至 2019 年间诊断为 GIST 的 1213 例患者的监测、流行病学和最终结果（SEER）数据库数据按 2:1 的比例分为建模集和验证集。对于建模集，使用单变量和多变量 Cox 回归分析来识别独立的预后因素。然后根据这些决定因素构建列线图。在两个子集中使用受试者操作特征（ROC）曲线、校准曲线、临床决策曲线和风险分层分析来测试模型效能。
确定的预后决定因素包括年龄、性别、病理分化程度、肿瘤-淋巴结-转移（TNM）分期、手术干预、放疗和婚姻状况。构建的列线图在建模集中 1 年、3 年和 5 年总生存期（OS）的 ROC 曲线下面积（AUC）值分别为 0.822、0.793 和 0.779，而在验证集中，这些值分别为 0.796、0.823 和 0.806。两个数据集的校准图证实了预测生存期和观察到的生存期之间的一致性。决策曲线分析（DCA）表明列线图具有显著的临床实用性。患者数据的风险分层显示，两个数据集中高危和低危队列之间存在明显的生存差异（P<0.001）。
已引入一种用于 GIST 预后的新型有效列线图。该模型的准确性为临床决策提供了关键见解，但仍需进一步的外部验证。
