Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2023; 15(12): 350-358
Published online Dec 28, 2023. doi: 10.4329/wjr.v15.i12.350
Factors associated with gastrointestinal stromal tumor rupture and pathological risk: A single-center retrospective study
Jia-Zheng Liu, Zhong-Wen Jia, Ling-Ling Sun
Jia-Zheng Liu, Zhong-Wen Jia, Ling-Ling Sun, Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110033, Liaoning Province, China
Author contributions: Jia ZW conceived the idea; Liu JZ and Sun LL collected and analyzed the data; Liu JZ wrote the paper; all the authors discussed the results and contributed to the final manuscript.
Institutional review board statement: The study was reviewed and approved by The Fourth Affiliated Hospital of China Medical University Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors have no conflicts of interest to disclose.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.
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 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: Zhong-Wen Jia, PhD, Chief Physician, Department of Radiology, The Fourth Affiliated Hospital of China Medical University, No. 4 Chongshan East Road, Huanggu District, Shenyang 110033, Liaoning Province, China. jiazhongwen@126.com
Received: August 26, 2023
Peer-review started: August 26, 2023
First decision: October 9, 2023
Revised: October 26, 2023
Accepted: December 12, 2023
Article in press: December 12, 2023
Published online: December 28, 2023
Processing time: 121 Days and 12 Hours
Abstract
BACKGROUND

Gastrointestinal stromal tumor (GIST) is a rare gastrointestinal mesenchymal tumor with potential malignancy. Once the tumor ruptures, regardless of tumor size and mitotic number, it can be identified into a high-risk group. It is of great significance for the diagnosis, treatment, and prognosis of GIST if non-invasive examination can be performed before surgery to accurately assess the risk of tumor.

AIM

To identify the factors associated with GIST rupture and pathological risk.

METHODS

A cohort of 50 patients with GISTs, as confirmed by postoperative pathology, was selected from our hospital. Clinicopathological and computed tomography data of the patients were collected. Logistic regression analysis was used to evaluate factors associated with GIST rupture and pathological risk grade.

RESULTS

Pathological risk grade, tumor diameter, tumor morphology, internal necrosis, gas-liquid interface, and Ki-67 index exhibited significant associations with GIST rupture (P < 0.05). Gender, tumor diameter, tumor rupture, and Ki-67 index were found to be correlated with pathological risk grade of GIST (P < 0.05). Multifactorial logistic regression analysis revealed that male gender and tumor diameter ≥ 10 cm were independent predictors of a high pathological risk grade of GIST [odds ratio (OR) = 11.12, 95% confidence interval (95%CI): 1.81-68.52, P = 0.01; OR = 22.96, 95%CI: 2.19-240.93, P = 0.01]. Tumor diameter ≥ 10 cm, irregular shape, internal necrosis, gas-liquid interface, and Ki-67 index ≥ 10 were identified as independent predictors of a high risk of GIST rupture (OR = 9.67, 95%CI: 2.15-43.56, P = 0.01; OR = 35.44, 95%CI: 4.01-313.38, P < 0.01; OR = 18.75, 95%CI: 3.40-103.34, P < 0.01; OR = 27.00, 95%CI: 3.10-235.02, P < 0.01; OR = 4.43, 95%CI: 1.10-17.92, P = 0.04).

CONCLUSION

Tumor diameter, tumor morphology, internal necrosis, gas-liquid, and Ki-67 index are associated with GIST rupture, while gender and tumor diameter are linked to the pathological risk of GIST. These findings contribute to our understanding of GIST and may inform non-invasive examination strategies and risk assessment for this condition.

Keywords: Gastrointestinal stromal tumors; Imaging findings; Tumor rupture; Pathological risk grades

Core Tip: Gastrointestinal stromal tumor (GIST) biopsy is inconvenient, has a low yield, and easily leads to tumor metastasis. It is of great significance for the diagnosis, treatment, and prognosis of GIST if non-invasive examination can be performed before surgery to accurately assess the risk of tumor. The results of our study found that tumor diameter, tumor morphology, internal necrosis, and gas-liquid interface are related to the rupture of GIST, and sex and tumor diameter are related to the pathological risk of GIST. The results of this study provides ideas for non-invasive examination and risk assessment of GIST.