Abstract:drafted the manuscript and Hao Hu, Pinghong Zhou revised it. Pinghong Zhou and Hao Hu designed this project and mapped the structure, meanwhile Liang Zhu and Jie He gave the suggestions for the analyses.
“…Colorectal GISTs, mesenchymal malignancy, only accounts for about 6% of GISTs ( 5 ), but prognosis is generally poor ( 6 a; 7 ). Although previous studies indicate that tumor size, mitotic index, surgery, AJCC stage can be powerful prognostic factors of survival and oncological events ( 8 , 10 , 30 – 35 ), it remains ambiguous whether clinicopathological features have prognostic value in patients with colorectal GISTs because of the rarity of this disease. Meanwhile, colorectal GISTs remain a predicament for clinicians and scientists to predict clinical behavior.…”
BackgroundColorectal gastrointestinal stromal tumors (GISTs), mesenchymal malignancy, only accounts for about 6% of GISTs, but prognosis is generally poor. Given the rarity of colorectal GISTs, the prognostic values of clinicopathological features in the patients remain unclear. Nomograms can provide a visual interface to help calculate the predicted probability of a patient meeting a specific clinical endpoint and communicate it to the patient.MethodsWe included a total of 448 patients with colorectal GISTs diagnosed between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. For nomogram construction and validation, patients in the SEER database were divided randomly into the training cohort and internal validation cohort at a ratio of 7:3, while 44 patients with colorectal GISTs from our hospital patient data set between 2010 to 2016 served as the external validation cohort. The OS curves were drawn using the Kaplan–Meier method and assessed using the log-rank test. And, Fine and Gray’s competing-risks regression models were conducted to assess CSS. We performed univariate and multivariate analyses to select prognostic factors for survival time and constructed a predictive nomogram based on the results of the multivariate analysis.ResultsThrough univariate and multivariate analyses, it is found that age, primary site, SEER stage, surgery, and tumor size constitute significant risk factors for OS, and age, primary site, histological grade, SEER stage, American Joint Committee for Cancer (AJCC) stage, surgery, and tumor size constitute risk factors for CSS. We found that the nomogram provided a good assessment of OS and CSS at 1-, 3- and 5- year in patients with colorectal GISTs. The calibration plots for the training, internal validation and external validation cohorts at 1-, 3- and 5- year OS and CSS indicated that the predicted survival rates closely correspond to the actual survival rates.ConclusionWe constructed and validated an unprecedented nomogram to predict OS and CSS in patients with colorectal GISTs. The nomogram had the potential as a clinically predictive tool for colorectal GISTs prognosis, and can be used as a potential, objective and additional tool for clinicians in predicting the prognosis of colorectal GISTs patients worldwide. Clinicians could wield the nomogram to accurately evaluate patients’ OS and CSS, identify high-risk patients, and provide a baseline to optimize treatment plans.
“…Colorectal GISTs, mesenchymal malignancy, only accounts for about 6% of GISTs ( 5 ), but prognosis is generally poor ( 6 a; 7 ). Although previous studies indicate that tumor size, mitotic index, surgery, AJCC stage can be powerful prognostic factors of survival and oncological events ( 8 , 10 , 30 – 35 ), it remains ambiguous whether clinicopathological features have prognostic value in patients with colorectal GISTs because of the rarity of this disease. Meanwhile, colorectal GISTs remain a predicament for clinicians and scientists to predict clinical behavior.…”
BackgroundColorectal gastrointestinal stromal tumors (GISTs), mesenchymal malignancy, only accounts for about 6% of GISTs, but prognosis is generally poor. Given the rarity of colorectal GISTs, the prognostic values of clinicopathological features in the patients remain unclear. Nomograms can provide a visual interface to help calculate the predicted probability of a patient meeting a specific clinical endpoint and communicate it to the patient.MethodsWe included a total of 448 patients with colorectal GISTs diagnosed between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. For nomogram construction and validation, patients in the SEER database were divided randomly into the training cohort and internal validation cohort at a ratio of 7:3, while 44 patients with colorectal GISTs from our hospital patient data set between 2010 to 2016 served as the external validation cohort. The OS curves were drawn using the Kaplan–Meier method and assessed using the log-rank test. And, Fine and Gray’s competing-risks regression models were conducted to assess CSS. We performed univariate and multivariate analyses to select prognostic factors for survival time and constructed a predictive nomogram based on the results of the multivariate analysis.ResultsThrough univariate and multivariate analyses, it is found that age, primary site, SEER stage, surgery, and tumor size constitute significant risk factors for OS, and age, primary site, histological grade, SEER stage, American Joint Committee for Cancer (AJCC) stage, surgery, and tumor size constitute risk factors for CSS. We found that the nomogram provided a good assessment of OS and CSS at 1-, 3- and 5- year in patients with colorectal GISTs. The calibration plots for the training, internal validation and external validation cohorts at 1-, 3- and 5- year OS and CSS indicated that the predicted survival rates closely correspond to the actual survival rates.ConclusionWe constructed and validated an unprecedented nomogram to predict OS and CSS in patients with colorectal GISTs. The nomogram had the potential as a clinically predictive tool for colorectal GISTs prognosis, and can be used as a potential, objective and additional tool for clinicians in predicting the prognosis of colorectal GISTs patients worldwide. Clinicians could wield the nomogram to accurately evaluate patients’ OS and CSS, identify high-risk patients, and provide a baseline to optimize treatment plans.
“… 14 Intraoperative complications were defined as perforations and severe intraoperative bleeding (requirement for repeated endoscopic hemostasis with a postoperative hemoglobin drop of ≥2 g/dL or requirement for surgical assistance). 15 Postoperative complications were defined as delayed bleeding episodes confirmed by emergency endoscopy, delayed perforation confirmed by X-ray or computed tomography, and postoperative infection. All procedures were performed by endoscopists with different experience levels.…”
Objective Endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) is a commonly used treatment; however, it is associated with a risk of conversion to laparoscopic resection (LR). This study was performed to identify factors influencing conversion from ER to LR and the effects of conversion on outcomes. Methods The clinicopathological features of patients treated for gGISTs from March 2010 to May 2021 were retrospectively collected. Endpoints included the determination of risk factors associated with LR conversion, with comparisons of surgical outcomes with and without conversion. Propensity score matching was performed to compare the two groups. Results In total, 371 gGISTs were analyzed. Sixteen patients required conversion from ER to LR. Propensity score matching demonstrated that invasion depth (muscularis propria with exophytic growth) and gGIST size (≥3 cm) were independent risk factors for conversion to LR. The procedure duration (median, 160.5 vs. 60.0 minutes), postoperative hospitalization duration (median, 8 vs. 6 days), and postoperative fasting duration (median, 5 vs. 3 days) were significantly longer in patients who underwent conversion to LR. Conclusions Accurate preoperative measurements of tumor size and invasion depth may help determine more appropriate surgical approaches for patients with gGISTs.
“…In our practice, we offer patients with <2-cm GISTs either yearly surveillance with EUS, surgical referral, or endoscopic resection with curative intent to avoid long-term surveillance with a R0 resection. 3 , 4 , 5 , 6 Management options were discussed with the patient, and the decision was made to proceed with endoscopic full-thickness resection to ensure negative margins using an FTRD. Figure 1 Gastric subepithelial lesion.…”
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