Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study
Tao Chen, Liang-Ying Ye, Xing-Yu Feng, Hai-Bo Qiu, Peng Zhang, Yi-Xin Luo, Li-Yi Yuan, Xin-Hua Chen, Yan-Feng Hu, Hao Liu, Yong Li, Kai-Xiong Tao, Jiang Yu, Guo-Xin Li
Tao Chen, Yi-Xin Luo, Li-Yi Yuan, Xin-Hua Chen, Yan-Feng Hu, Hao Liu, Jiang Yu, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Liang-Ying Ye, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Xing-Yu Feng, Yong Li, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Hai-Bo Qiu, Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
Peng Zhang, Kai-Xiong Tao, Department of General Surgery, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Chen T, Ye LY, Feng XY, Qiu HB, Zhang P, Li Y, Tao KX, and Li GX designed the research; Chen T, Luo YX, Yuan LY, Chen XH, and Yu J performed the research; Hu YF and Liu H contributed new reagents/analytic tools; all authors wrote the paper.
Supported by the State Key Project of Research and Development Plan, No. 2017YFC0108300 and No. 2017YFC0108303; and 2018 Special Funds for the Cultivation of Guangdong College Students' Scientific and Technological Innovation (Climbing Program Special Funds), No. pdjha0094.
Institutional review board statement: The study was approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at gzliguoxin@163.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Guo-Xin Li, FRCS (Gen Surg), MD, PhD, Professor, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China.
gzliguoxin@163.com
Telephone: +86-20-61411681 Fax: +86-20-62787626
Received: November 12, 2018
Peer-review started: November 12, 2018
First decision: December 12, 2019
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 16, 2019
Published online: March 14, 2019
Processing time: 126 Days and 8.9 Hours
BACKGROUND
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.
AIM
To evaluate the application value of four different risk stratification systems for GISTs.
METHODS
Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health (NIH) criteria, the Armed Forces Institute of Pathology (AFIP) criteria, the Memorial Sloan Kettering Cancer Center (MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic (ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve (AUC).
RESULTS
A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields (HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm (P < 0.05), mitotic count > 5/50 HPFs (P < 0.05), non-gastric location (P < 0.05), and tumor rupture (P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC (0.754).
CONCLUSION
According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.
Core tip: Our study evaluated the application value of four different risk stratification systems for gastrointestinal stromal tumors (GISTs). Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database and were stratified by four different stratification systems. According to our data, the Armed Forces Institute of Pathology (AFIP) criteria were associated with a larger area under the curve than the National Institute of Health modified criteria, the Memorial Sloan Kettering Cancer Center nomogram, and the contour maps, which indicated that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.
