Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2024; 30(28): 3403-3417
Published online Jul 28, 2024. doi: 10.3748/wjg.v30.i28.3403
GATIS score for predicting the prognosis of rectal neuroendocrine neoplasms: A Chinese multicenter study of 12-year experience
Xin-Yu Zeng, Ming Zhong, Guo-Le Lin, Cheng-Guo Li, Wei-Zhong Jiang, Wei Zhang, Li-Jian Xia, Mao-Jun Di, Hong-Xue Wu, Xiao-Feng Liao, Yue-Ming Sun, Min-Hao Yu, Kai-Xiong Tao, Yong Li, Rui Zhang, Peng Zhang
Xin-Yu Zeng, Cheng-Guo Li, Kai-Xiong Tao, Peng Zhang, Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, Hubei Province, China
Ming Zhong, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Guo-Le Lin, Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
Wei-Zhong Jiang, Department of Colorectal Surgery, Fujian Medical University, Fuzhou 350401, Fujian Province, China
Wei Zhang, Department of Colorectal Surgery, Changhai Hospital, Shanghai 200433, China
Li-Jian Xia, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan 250118, Shandong Province, China
Mao-Jun Di, Department of Gastrointestinal Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442099, Hubei Province, China
Hong-Xue Wu, Department of Gastrointestinal Surgery I Section, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Xiao-Feng Liao, Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, Hubei Province, China
Yue-Ming Sun, Department of Colorectal Surgery, Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Min-Hao Yu, Department of Gastrointestinal Surgery, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Yong Li, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Rui Zhang, Department of Colorectal Surgery, Liaoning Cancer Hospital, Shenyang 110042, Liaoning Province, China
Co-first authors: Xin-Yu Zeng and Ming Zhong.
Co-corresponding authors: Rui Zhang and Peng Zhang.
Author contributions: Zeng XY and Zhong M contributed equally to this article. Li Y, Zhang R, and Zhang P had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Zeng XY, Li Y, Zhang R, and Zhang P contributed to the concept and design of this study; Zeng XY, Zhong M, Lin GL, Li CG, Jiang WZ, Zhang W, Xia LJ, Di MJ, Wu HX, Liao XF, Sun YM, Yu MH, and Tao KX participated in the acquisition, analysis, or interpretation of data; Zeng XY, Zhong M, and Lin GL drafted the manuscript; Li CG, Jiang WZ, Zhang W, Xia LJ, Di MJ, Wu HX, Liao XF, Sun YM, Yu MH, Tao KX, Li Y, Zhang R, and Zhang P involved in the critical revision of the manuscript for important intellectual content; Li CG, Jiang WZ, Zhang W, Xia LJ, Di MJ, and Wu HX contributed in the statistical analysis; Liao XF, Sun YM, Yu MH, Tao KX, Li Y, Zhang R, and Zhang P provided administrative, technical, or material support; Zhang R and Zhang P contributed to the supervision of this manuscript and should be considered as co-corresponding authors.
Supported by National Natural Science Foundation of China, No. 82072736 and No. 81874184; and the Key Project of Hubei Health Commission, No. WJ2019Q030.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of all 17 participating centers.
Informed consent statement: At the last follow-up, we informed the alive patients about the study in detail and obtained the informed consent signed by them. For patients who were not alive at the time of the study, we contacted their immediate family members, explained the study in detail and obtained the informed consent forms signed by them.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng Zhang, MD, Surgeon, Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430074, Hubei Province, China.zhangpengwh@hust.edu.cn
Received: March 5, 2024
Revised: June 4, 2024
Accepted: July 10, 2024
Published online: July 28, 2024
Processing time: 140 Days and 21.9 Hours
Abstract
BACKGROUND

There is currently a shortage of accurate, efficient, and precise predictive instruments for rectal neuroendocrine neoplasms (NENs).

AIM

To develop a predictive model for individuals with rectal NENs (R-NENs) using data from a large cohort.

METHODS

Data from patients with primary R-NENs were retrospectively collected from 17 large-scale referral medical centers in China. Random forest and Cox proportional hazard models were used to identify the risk factors for overall survival and progression-free survival, and two nomograms were constructed.

RESULTS

A total of 1408 patients with R-NENs were included. Tumor grade, T stage, tumor size, age, and a prognostic nutritional index were important risk factors for prognosis. The GATIS score was calculated based on these five indicators. For overall survival prediction, the respective C-indexes in the training set were 0.915 (95% confidence interval: 0.866-0.964) for overall survival prediction and 0.908 (95% confidence interval: 0.872-0.944) for progression-free survival prediction. According to decision curve analysis, net benefit of the GATIS score was higher than that of a single factor. The time-dependent area under the receiver operating characteristic curve showed that the predictive power of the GATIS score was higher than that of the TNM stage and pathological grade at all time periods.

CONCLUSION

The GATIS score had a good predictive effect on the prognosis of patients with R-NENs, with efficacy superior to that of the World Health Organization grade and TNM stage.

Keywords: Rectal neuroendocrine neoplasm; Nomogram; Random forest; Prognosis; Overall survival; Progression-free survival

Core Tip: We utilized the data of 1408 patients with rectal neuroendocrine neoplasms from a large multicenter database of 17 large-scale Chinese medical centers. We found that tumor grade, T stage, tumor size, age, and a prognostic nutritional index were independent predictors of prognosis in patients with rectal neuroendocrine neoplasms. In addition, we constructed the GATIS score for overall survival and progression-free survival in these patients, which had a C-index of 0.915 for overall survival and 0.908 for progression-free survival; moreover, it showed a better predictive power than that of the TNM stage and pathological grade.