Nomogram for Predicting Risk of Esophagogastric Junction (EGJ) Resection During Laparoscopic Resection of Gastrointestinal Stromal Tumors in EGJ: A Retrospective Multicenter Study

Abstract

Background: The established criteria for determining whether to excise the cardia during laparoscopic surgery for gastrointestinal stromal tumors in the esophagogastric junction (EGJ-GISTs) remain controversial. This retrospective multicenter study was conducted to develop a nomogram for predicting the risk of the cardia excision during laparoscopic surgery for EGJ-GISTs.Material and Methods: We reviewed data from 2,127 gastric-GISTs (g-GISTs) patients without distant metastases in four hospital between June 2012 and June 2020. Of those, according to the including criteria, 184 patients [Guangdong Provincial Hospital of Chinese Medicine (n = 81), Nanfang Hospital of Southern Medical University (n = 60), Guangdong General Hospital (n = 34), and The Third Affiliated Hospital of Southern Medical University (n = 9)] with EGJ-GISTs were identified and included in this study. Factors contributing to risk of cardia excision were identified and used to create a nomogram. Nomogram performance was assessed using a bootstrapped concordance index (c-index) and calibration plots.Results: According to the multivariate analysis, the distance from the margin of the tumor to the esophagogastric line (EG-line) (cm) (OR = 0.001, 95% CI: 0.00001~0.056, P = 0.001) and tumor size (cm) (OR = 14.969, 95% CI: 1.876~119.410, P = 0.011) were significantly related to likelihood of cardia structure excision in laparoscopic surgery for EGJ-GISTs. These two factors were used to generate a nomogram for predicting risk of cardia excision using a logistic regression model; a bootstrapped C-index of 0.988 (calibrated C-index = 0.987) indicated strong predictive ability, with broad calibration.Conclusions: This nomogram based on distance from tumor margin to EG-line and tumor size may serve as a tool for predicting risk of cardia damage during laparoscopic removal of EGJ-GISTs to aid in selection of surgical methods and preoperative neoadjuvant therapy.

Computed tomography features of gastric leiomyoma versus gastric stromal tumor: a case–control study with propensity score matching

“…We found that the overall incidence of GSTs was much higher than that of GLs, which has also been confirmed by numerous postoperative pathological reports. 6 , 7 Although a tumor may have a predisposition for a specific site in some cases, the tumor site was considered a confounder in our study and thus excluded from the analysis. Therefore, we classified lesions in the cardia or fundus of the stomach into the same group.…”

“… 5 Common surgical treatments for gastric submucosal tumors include endoscopic and laparoscopic resection. 6 , 7 Although endoscopic biopsy plays a key role in diagnosing gastric submucosal tumors, multiphase contrast-enhanced computed tomography (CT) has advantages in evaluating the tumor location, tumor characteristics, invasion to surrounding tissues, and distant metastasis. 8 Applying CT in addition to endoscopic biopsy before the initiation of treatment for submucosal tumors will provide great clinical value.…”