The assessment of different risk classification systems for gastrointestinal stromal tumors (GISTs): the analytic results from the SEER database

Background. Marital status has been reported to be a prognostic factor in multiple malignancies. However, its prognostic value on gastrointestinal stromal tumors (GISTs) have not yet been determined. The objective of the present analysis was to assess the effects of marital status on survival in patients with GISTs. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze 6195 patients who were diagnosed with GISTs from 2001 to 2014. We also use Kaplan-Meier analysis and Cox regression to analyze the impact of marital status on cancer-specific survival (CSS). Results. Patients in the married group had more frequency in white people, more high/moderate grade tumors, and were more likely to receive surgery. Widowed patients had a higher proportion of women, a greater proportion of older patients (>60 years), and more common site of the stomach. Multivariate analysis demonstrated that marital status was an independent prognostic factor for GISTs (P<0.001). Married patients had better CSS than unmarried patients (P<0.001). Subgroup analysis suggested that widowed patients had the lowest CSS compared with all other patients. Conclusions. Marital status is a prognostic factor for survival in patients with GISTs, and widowed patients are at greater risk of cancer-specific mortality.

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Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience

Gastroenterology Research and Practice ◽

10.1155/2019/3087298 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Yingjie Guo ◽

Xue Jing ◽

Jian Zhang ◽

Xueli Ding ◽

Xiaoyu Li ◽

...

Keyword(s):

Tumor Size ◽

Gastrointestinal Stromal Tumors ◽

Average Length ◽

Risk Classification ◽

Low Risk ◽

Efficacy And Safety ◽

Endoscopic Removal ◽

Moderate Risk ◽

Stromal Tumors ◽

Gastric Gists

Background and Aims. Endoscopic removal of GISTs (gastrointestinal stromal tumors) is recently recognized, but less is known about its efficacy and safety. This study is aimed at assessing the feasibility, clinical efficacy, and safety of the endoscopic removal of gastric GISTs. Patients and Methods. Endoscopic removal (ER) of GISTs was performed in 134 patients at our hospital between January 2015 and January 2019. The clinical features, surgical outcomes, complications, pathological diagnosis, and risk classification were evaluated retrospectively. Results. ER was successful in 131 cases (98%), including 58 by ESD (endoscopic submucosal dissection), 43 by ESE (endoscopic submucosal excavation), 25 by EFTR (endoscopic full-thickness resection), and 5 by STER (submucosal tunneling endoscopic resection). In addition, GISTs of two cases were resected using LECS (laparoscopic and luminal endoscopic cooperative surgery) for the extraluminal and intraluminal growth pattern. The average tumor size was 1.89±1.25 cm (range: 0.5-6.0 cm). Of these patients, 26 cases had a large tumor size (range: 2.0-6.0 cm), and endoscopic removal was successful in all of them. During the procedure, endoclips were used to close the perforation in all cases, without conversion to open surgery. The average length of hospital stay was 5.50±2.15 days (range: 3-10 days). In the risk classification, 106 (79.7%) were of a very low risk, 25 (18.8%) of a low risk, and 2 (1.5%) of a moderate risk. The moderate-risk cases were treated with imatinib mesylate after ER. No recurrence or metastasis was observed during the follow-up period of 23±8 months (range: 3-48 months). Conclusions. The endoscopic treatment is feasible, effective, and safe for gastric GISTs, and individualized choice of approaches is recommended for GISTs.

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Radiomics of Gastrointestinal Stromal Tumors; Risk Classification Based on Computed Tomography Images – A Pilot Study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2019.11.011 ◽

2020 ◽

Vol 46 (2) ◽

pp. e6

Author(s):

Milea Timbergen ◽

Martijn P.A. Starmans ◽

Melissa Vos ◽

Michel Renckens ◽

Dirk J. Grünhagen ◽

...

Keyword(s):

Computed Tomography ◽

Pilot Study ◽

Gastrointestinal Stromal Tumors ◽

Risk Classification ◽

Stromal Tumors ◽

Computed Tomography Images

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Survival and Incidence in Gastrointestinal Stromal Tumors: A Comprehensive Epidemiological Analysis of 5,411 Cases from 1993-2009 Using the SEER Database

The American Journal of Gastroenterology ◽

10.14309/00000434-201310001-02141 ◽

2013 ◽

Vol 108 ◽

pp. S650

Author(s):

Neal Patel ◽

Nicolas Patel ◽

Parmvir Singh ◽

Nicole Patel ◽

Sunil Patel ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Seer Database ◽

Epidemiological Analysis ◽

Stromal Tumors

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MRI-Based Radiomics Models for Predicting Risk Classification of Gastrointestinal Stromal Tumors

Frontiers in Oncology ◽

10.3389/fonc.2021.631927 ◽

2021 ◽

Vol 11 ◽

Author(s):

Haijia Mao ◽

Bingqian Zhang ◽

Mingyue Zou ◽

Yanan Huang ◽

Liming Yang ◽

...

Keyword(s):

High Risk ◽

Random Forest ◽

Gastrointestinal Stromal Tumors ◽

Roc Curves ◽

Risk Classification ◽

Low Risk ◽

Intermediate Risk ◽

Stromal Tumors ◽

Mr Sequences

BackgroundWe conduct a study in developing and validating four MRI-based radiomics models to preoperatively predict the risk classification of gastrointestinal stromal tumors (GISTs).MethodsForty-one patients (low-risk = 17, intermediate-risk = 13, high-risk = 11) underwent MRI before surgery between September 2013 and March 2019 in this retrospective study. The Kruskal–Wallis test with Bonferonni correction and variance threshold was used to select appropriate features, and the Random Forest model (three classification model) was used to select features among the high-risk, intermediate-risk, and low-risk of GISTs. The predictive performance of the models built by the Random Forest was estimated by a 5-fold cross validation (5FCV). Their performance was estimated using the receiver operating characteristic (ROC) curve, summarized as the area under the ROC curve (AUC). Area under the curve (AUC), accuracy, sensitivity, and specificity for risk classification were reported. Linear discriminant analysis (LDA) was used to assess the discriminative ability of these radiomics models.ResultsThe high-risk, intermediate-risk, and low-risk of GISTs were well classified by radiomics models, the micro-average of ROC curves was 0.85, 0.81, 0.87 and 0.94 for T1WI, T2WI, ADC and combined three MR sequences. And ROC curves achieved excellent AUCs for T1WI (0.85, 0.75 and 0.82), T2WI (0.69, 0.78 and 0.78), ADC (0.85, 0.77 and 0.80) and combined three MR sequences (0.96, 0.92, 0.81) for the diagnosis of high-risk, intermediate-risk, and low-risk of GISTs, respectively. In addition, LDA demonstrated the different risk of GISTs were correctly classified by radiomics analysis (61.0% for T1WI, 70.7% for T2WI, 83.3% for ADC, and 78.9% for the combined three MR sequences).ConclusionsRadiomics models based on a single sequence and combined three MR sequences can be a noninvasive method to evaluate the risk classification of GISTs, which may help the treatment of GISTs patients in the future.

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C-Reactive Protein/Albumin Ratio Is a Powerful Prognostic Indicator for Survival in Surgically Resected Gastrointestinal Stromal Tumors: A Retrospective Cohort Study

10.21203/rs.3.rs-192934/v1 ◽

2021 ◽

Author(s):

Xianglong Cao ◽

Jian Cui ◽

Zijian Li ◽

Gang Zhao

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Cox Regression ◽

Independent Predictor ◽

Multivariable Analysis ◽

Risk Classification ◽

C Reactive Protein ◽

Term Survival ◽

Albumin Ratio ◽

Stromal Tumors ◽

Reactive Protein

Abstract Background Systemic inflammation and malnutrition may promote tumor progression. C-reactive protein/albumin ratio (CAR) is linked with poor long-term survival of several malignant tumors.Purpose To explore the predictive value of CAR in gastrointestinal stromal tumors (GISTs).Methods A retrospective study was conducted on 325 patients with GIST who underwent radical surgery from 2009 to 2018. The cut-off point of CAR was set using X-tile software. Kaplan-Meier method and multivariate Cox regression model were used to study the prognostic value of CAR. The time-dependent receiver operating characteristic curve(tROC) was drawn, and the prognostic accuracy of CAR, Glasgow prognosis score (GPS), and NIH risk classification was compared by the area under the curve (AUC).Results The best cut-off point of CAR was 0.55. Increased CAR was associated with the location of the lower digestive tract, larger tumor size, higher mitotic index, higher NIH risk classification, lower ALB, higher CRP, and higher GPS (all p<0.05). Multivariable analysis revealed that CAR (hazard ratio [HR] 2.598, 95% confidence interval [CI] 1.385-4.874; p=0.003) was an independent predictor of overall survival. Additionally, the AUC of CAR was lower than that of NIH risk classification at 2-year (0.601vs. 0.775, p=0.002) and 5-year (0.629 vs. 0.735, p=0.069). However, the AUC of NIH risk classification was significantly increased (2-year OS 0.801, p=0.251; 5-year OS 0.777, p=0.011) when it was combined with CAR.Conclusions CAR is a new independent predictor of poor survival in patients with GIST. CAR combined with NIH risk classification can effectively improve the performance of prognosis prediction.

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A new nomogram for recurrence-free survival prediction of gastrointestinal stromal tumors: Comparison with current risk classification methods

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.12.014 ◽

2018 ◽

Cited By ~ 1

Author(s):

Tao Chen ◽

Lili Xu ◽

Liangying Ye ◽

Haibo Qiu ◽

Yanfeng Hu ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Risk Classification ◽

Survival Prediction ◽

Recurrence Free Survival ◽

Classification Methods ◽

Free Survival ◽

Stromal Tumors ◽

Current Risk

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Nationwide trends in diagnosis and outcomes of gastrointestinal stromal tumors in the era of targeted therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.121 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 121-121

Author(s):

E. R. Witkowski ◽

J. K. Smith ◽

S. Ng ◽

T. P. McDade ◽

S. A. Shah ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Kinase Inhibitors ◽

Population Level ◽

Steady Increase ◽

Seer Database ◽

New Era ◽

Stromal Tumors ◽

Risk Of Death ◽

Kaplan Meier ◽

Precise Diagnosis

121 Background: Gastrointestinal stromal tumors (GISTs) have historically been inconsistently categorized in tumor registries. Discovery of c-kit expression in 1998 allowed for more precise diagnosis, and use of tyrosine kinase inhibitors for GIST in 2000 marked a new era in management. We examined nationwide trends in the diagnosis, management, and outcomes of GIST in this post-imatinib era. Methods: Patients ≥ 18 years old with GIST were identified in the SEER database 1998-2007, using the GIST-specific ICD-O-3 code. After a period of steady increase, incidence stabilized after 2001. Trends from 2002 to 2007 were examined. Univariate and multivariate analyses were performed. This cohort was further divided into 2002-2004 and 2005-2007 for survival analysis by Kaplan-Meier methods and Cox proportional-hazard ratios. Results: 3,604 patients were identified. There was a dramatic increase in diagnoses from 1998 to 2001 (109 to 376 cases, p < 0.0001), but no significant change from 2002 to 2007 (p = 0.572). During this period of stable incidence (2002-2007), the proportion of patients recommended for surgery continued to decrease (85.2% to 80.1%, p = 0.0006), while utilization of radiation (which dropped to 1.1% by 2001) remained relatively constant (p = 0.101). Anatomic distribution remained stable (p = 0.529), with stomach (52.9%) and small bowel (29.3%) predominating. There was also no change in stage distribution (p = 0.811). Late stage, black race, and advanced age were predictive of not receiving resection. Female sex, younger age, local disease, later year of diagnosis, and resection were associated with lower risk of death. Survival for patients diagnosed in 2005-2007 improved over 2002-2004 for both unresected (p = 0.027) and resected (p = 0.0998) groups. Resection was an independent predictor of survival in both periods (p < 0.0001). Conclusions: Incidence of GIST as identified in the SEER database has stabilized 2002-2007, likely reflecting more accurate diagnosis. Survival for both resected and unresected patients has improved since the introduction of imatinib, and continues upward. These population-level findings confirm the significant benefit of surgical therapy beyond clinical trials. No significant financial relationships to disclose.

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