Cancer Management and Research (Nov 2020)

Nomogram to Predict Preoperative Occult Peritoneal Metastasis of Gastrointestinal Stromal Tumors (GIST) Based on Imaging and Inflammatory Indexes

  • Xu SJ,
  • Lin GS,
  • Ling HJ,
  • Guo RJ,
  • Chen J,
  • Liao YM,
  • Lin T,
  • Zhou YJ

Journal volume & issue
Vol. Volume 12
pp. 11713 – 11721

Abstract

Read online

Shao-Jun Xu,1– 3,* Guo-Sheng Lin,1– 3,* Hong-Jian Ling,1– 3,* Ren-Jie Guo,1– 3,* Jie Chen,1– 3 Yi-Ming Liao,1– 3,* Tao Lin,1– 3 Yong-Jian Zhou1– 3,* 1Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China; 2Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China; 3Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yong-Jian Zhou; Tao Lin Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou 350001 Fujian Province, People’s Republic of ChinaTel/Fax +86-591-8336336Email [email protected]; [email protected]: Preoperative imaging examination is the primary method for diagnosing metastatic gastrointestinal stromal tumor (GIST), but it is associated with a high rate of missed diagnosis. Therefore, it is important to establish an accurate model for predicting occult peritoneal metastasis (PM) of GIST.Patients and Methods: GIST patients seen between April 2002 and December 2018 were selected from an institutional database. Using multivariate logistic regression analyses, we created a nomogram to predict occult PM of GIST and validated it with an independent cohort from the same center. The concordance index (C-index), decision curve analysis (DCA) and a clinical impact curve (CIC) were used to evaluate its predictive ability.Results: A total of 522 eligible GIST patients were enrolled in this study and divided into training (n=350) and validation cohorts (n=172). Factors associated with occult PM were included in the model: tumor size (odds ratio [OR] 1.194 95% confidence interval [CI], 1.034– 1.378; p=0.016), primary location (OR 7.365 95% CI, 2.192– 24.746; p=0.001), tumor capsule (OR 4.282 95% CI, 1.209– 15.166; p=0.024), Alb (OR 0.813 95% CI, 0.693– 0.954; p=0.011) and FIB (OR 2.322 95% CI, 1.410– 3.823; p=0.001). The C-index was 0.951 (95% CI, 0.917– 0.985) in the training cohort and 0.946 (95% CI, 0.900– 0.992) in the validation cohort. In the training cohort, the prediction model had a sensitivity of 82.8%, a specificity of 93.8%, a positive predictive value of 54.7%, and a negative predictive value of 98.4%; the validation cohort values were 94.7%, 85.0%, 43.9% and 99.2%, respectively. DCA and CIC results showed that the nomogram had clinical value in predicting occult PM in GIST patients.Conclusion: Imaging and inflammatory indexes are significantly associated with microscopic metastases of GIST. A nomogram including these factors would have an excellent ability to predict occult PM.Keywords: gastrointestinal stromal tumor, occult peritoneal metastasis, predictors, imaging index, inflammatory marker

Keywords