Luo Xiao, Chen Jinyao, Fang Yicheng, Xu Qinhui, Jiang Fei, Wang Guanliang
grid.469636.8Zhejiang Taizhou Hospital, Linhai, China.
Abdom Radiol (NY). 2025 Feb;50(2):579-588. doi: 10.1007/s00261-024-04544-w. Epub 2024 Aug 24.
Risk assessment of gastric gastrointestinal stromal tumors (GISTs), particularly those with a diameter ≤ 5 cm, remains a clinical challenge. Previous research has primarily focused on tumor size, ulceration, necrosis, and enhancement patterns, with less emphasis on the role of tumor calcification, which remains controversial regarding its correlation with malignancy risk.
This study aims to explore the characteristics of calcification in gastric GISTs and its correlation with risk stratification as defined by the National Institutes of Health (NIH), to improve preoperative risk assessment for gastric GISTs ≤ 5 cm.
A retrospective analysis of 385 pathologically confirmed gastric GIST patients, including 178 with small gastric GISTs (< 2 cm), was conducted. Tumors were categorized into low-risk (very low / low) and high-risk (intermediate / high) groups based on NIH criteria. Variables such as age, gender, tumor long-axis diameter, calcification rates, calcification size, the number and distribution of calcification, calcification to tumor long-axis diameter ratio were analyzed. Logistic regression was used to identify independent predictors of malignancy for gastric GISTs, with predictive values assessed via receiver operating characteristic (ROC) curves.
Significant differences were found between high-risk and low-risk groups in treatment methods, tumor long-axis diameter, the ratio of calcification to tumor long-axis, and calcification distribution (P < 0.05). Calcification rates varied across risk categories, with 23.6% in very low-risk, 31.6% in low-risk, 9.8% in intermediate-risk, and 31.7% in high-risk categories (P < 0.05). In GISTs ≤ 5 cm, both tumor long-axis diameter (OR = 3.07, 95% CI: 2.29-4.10) and calcification (OR = 0.36, 95% CI: 0.13-0.97) were independent predictors of malignancy risk (both P < 0.05). ROC curve analysis yielded areas of 0.849 for tumor long-axis diameter, 0.578 for calcification, and 0.862 for their combination.
The study indicates lower calcification rates in intermediate-risk gastric GISTs and higher rates in other risk categories. Additionally, tumors of different sizes exhibit two distinct calcification patterns, suggesting possible differing mechanisms of calcification in tumors. Calcification in gastric GISTs ≤ 5 cm acts as a protective factor against higher malignancy risk, and when combined with tumor long-axis diameter, significantly enhances predictive accuracy over long-axis diameter alone.
胃胃肠道间质瘤（GIST）的风险评估，尤其是直径≤5 cm的肿瘤，仍然是一项临床挑战。以往的研究主要集中在肿瘤大小、溃疡、坏死和强化模式上，对肿瘤钙化的作用关注较少，其与恶性风险的相关性仍存在争议。
本研究旨在探讨胃GIST钙化的特征及其与美国国立卫生研究院（NIH）定义的风险分层的相关性，以改善直径≤5 cm的胃GIST的术前风险评估。
对385例经病理确诊的胃GIST患者进行回顾性分析，其中包括178例小胃GIST（<2 cm）。根据NIH标准，将肿瘤分为低风险（极低/低）和高风险（中/高）组。分析年龄、性别、肿瘤长径、钙化率、钙化大小、钙化数量和分布、钙化与肿瘤长径比等变量。采用Logistic回归确定胃GIST恶性的独立预测因素，并通过受试者工作特征（ROC）曲线评估预测价值。
高风险组和低风险组在治疗方法、肿瘤长径、钙化与肿瘤长径比及钙化分布方面存在显著差异（P<0.05）。钙化率因风险类别而异，极低风险组为23.6%，低风险组为31.6%，中风险组为9.8%，高风险组为31.7%（P<0.05）。在直径≤5 cm的GIST中，肿瘤长径（OR=3.07，95%CI：2.29-4.10）和钙化（OR=0.36，95%CI：0.13-0.97）均为恶性风险的独立预测因素（均P<0.05）。ROC曲线分析显示，肿瘤长径的曲线下面积为0.849，钙化为0.578，两者联合为0.862。
该研究表明，中风险胃GIST的钙化率较低，其他风险类别的钙化率较高。此外，不同大小的肿瘤表现出两种不同的钙化模式，提示肿瘤钙化机制可能不同。直径≤5 cm的胃GIST钙化是恶性风险较高的保护因素，与肿瘤长径联合使用时，显著提高了单独使用长径的预测准确性。
