Novel Prognostic Nomogram for Recurrence-Free Survival of Patients With Primary Gastrointestinal Stromal Tumors After Surgical Resection: Combination of Prognostic Nutritional Index and Basic Variables

Abstract

BackgroundGastrointestinal stromal tumor (GIST) is the most common type of mesenchymal tumors in the digestive tract, often recrudescing even after R0 resection. Adjuvant tyrosine kinase inhibitor therapy prolonged recurrence-free survival (RFS). This study aimed to develop a novel nomogram for predicting the RFS of patients following surgical resection of GISTs.MethodsClinicopathologic data of patients with GISTs at Tianjin Medical University General Hospital (Tianjin, China) from January 2000 to October 2019 were retrospectively reviewed. Univariate and multivariate Cox regression analyses were used to select the suitable variables from the training cohort to construct a nomogram for 2- and 5-year RFS. The 1,000 bootstrap samples and calibration curves were used to validate the discrimination of the nomogram. The receiver operating characteristic analysis(ROC) was used to compare the predictive ability of the nomogram and present four commonly used risk stratification systems: National Institutes of Health (NIH)–Fletcher staging system; NIH–Miettinen criteria; Modified NIH criteria; and Air Forces Institute of Pathology risk criteria (AFIP).ResultsUnivariate and multivariate analyses showed that the tumor site, tumor size, mitotic index, tumor rupture, and prognostic nutritional index were significant factors associated with RFS. These variables were selected to create the nomogram for 2- and 5-year RFS (all P<0.05). The 2- and 5-year the ROC of the nomogram were 0.821 (95% confidence interval [CI]: 0.740–0.903) and 0.798 (95% CI: 0.739–0.903); NIH–Fletcher criteria were 0.757 (95% CI: 0.667–0.846) and 0.683 (95% CI: 0.613–0.753); NIH–Miettinen criteria were 0.762 (95% CI: 0.678–0.845) and 0.718 (95% CI: 0.653–0.783); Modified NIH criteria were 0.750 (95% CI: 0.661–0.838) and 0.689 (95% CI: 0.619–0.760); and AFIP were 0.777 (95% CI: 0.685–0.869) and 0.708 (95% CI: 0.636–0.780). Hence, the predictive probabilities of our nomogram are better than those of other GIST risk stratification systems.ConclusionThis nomogram, combining tumor site, tumor size, mitotic index, tumor rupture, and prognostic nutritional index, may assist physicians in providing individualized treatment and surveillance protocols for patients with GISTs following surgical resection.

The prognostic significance of prognostic nutritional index in gastrointestinal stromal tumors: A systematic review and meta-analysis

“…After reading the full text of these 11 articles, 2 that did not provide enough data and another 2 found to be published by the same center [ 11 , 14 ] were excluded so that finally 8 retrospective studies including 2627 patients with GISTs that fully met the requirements were adopted for the current meta-analysis. [ 8 , 11 – 13 , 15 – 18 ]…”

“…[ 17 ] Fourth, most of the cutoff values for the PNI were determined by receiver operator characteristic curve analysis and were not consistent, [ 8 , 12 , 15 , 16 , 18 ] but half of them were concentrated around 47.5. [ 8 , 12 , 13 , 16 ] Therefore, optimal cutoff values still need to be determined by more well-designed studies. Fifth, the sample size of the included studies was <500, ranging from 200 to 445, which may make it difficult to draw firm conclusions.…”

“…Because all studies met the inclusion criteria reported just for the recurrence-free survival (RFS), here, we took this parameter as the only endpoint. [8,[11][12][13][14][15][16][17][18] The Newcastle-Ottawa quality assessment scale was utilized to assess the quality of the included studies. [24]…”

“…In fact, unlike GI epithelial cancers, the existing risk assessment criteria and prognostic parameters for GISTs are self-contained and developing. [ 6 , 13 ] Accordingly, we conducted a meta-analysis to verify the prognostic significance of PNI in GISTs. This is the first meta-analysis in this field.…”

Development and validation of a prognostic model to predict the prognosis of patients with colorectal gastrointestinal stromal tumor: A large international population-based cohort study

“…Complete surgical resection is currently considered the standard treatment for patients with resectable GISTs with the goal of curing. Unfortunately, GISTs recurrence, even after the entire resection of the tumor and negative margins, is still frequently observed in clinical settings ( 10 , 11 ). In recent decades, there has been a great interest in determining the genetic characteristics of these neoplasms, and it was identified and determined that GISTs are characteristically driven by activating mutations of KIT in approximately 85–90% of cases ( 12 – 14 ).…”