Prognostic nomogram in patients with gastrointestinal stromal tumors: a SEER-based study

Pan Xu; Wei Ding; Feifei Zheng; Tingyan Ruan; Jing Liu; Junli Ding; Junying Xu

doi:10.21037/jgo-24-27

Prognostic nomogram in patients with gastrointestinal stromal tumors: a SEER-based study

J Gastrointest Oncol. 2024 Feb 29;15(1):112-124. doi: 10.21037/jgo-24-27. Epub 2024 Feb 28.

Authors

Pan Xu^#¹, Wei Ding^#², Feifei Zheng³, Tingyan Ruan¹, Jing Liu¹, Junli Ding¹, Junying Xu¹

Affiliations

¹ Oncology Department, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China.
² Gastroenterology, Naval Medical Center of PLA, Shanghai, China.
³ Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China.

^# Contributed equally.

Abstract

Background: Gastrointestinal stromal tumor (GIST) is a common mesenchymal tumor of the gastrointestinal system. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT.

Methods: Data from the Surveillance Epidemiology, and End Results (SEER) database of 1,213 patients diagnosed with GIST between 2010 and 2019 were dichotomized into a modeling set and a validation set at a 2:1 ratio. For the modeling set, both univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. A nomogram was then constructed based on these determinants. Model efficacy was tested using receiver operating characteristic (ROC) curves, calibration curves, clinical decision curves, and risk stratification analysis in both subsets.

Results: Identified prognostic determinants included age, sex, pathological differentiation level, tumor-node-metastasis (TNM) stage, surgical intervention, radiotherapy, and marital status. The constructed nomogram showed area under the ROC curve (AUC) values of 0.822, 0.793, and 0.779 for 1-, 3-, and 5-year overall survival (OS) in the modeling set, respectively, while in the validation set, the values were 0.796, 0.823, and 0.806, respectively. Calibration plots from both sets confirmed the concordance between predicted and observed survival. Decision curve analysis (DCA) indicated significant clinical utility for the nomogram. Risk stratification of the patient data revealed distinct survival differences between high-risk and low-risk cohorts in both sets (P<0.001).

Conclusions: A novel and potent nomogram for the prognosis of GIST has been introduced. This model's precision offers crucial insights for clinical decisions, yet further external validation remains essential.

Keywords: Gastrointestinal stromal tumor (GIST); Surveillance Epidemiology, and End Results database (SEER database); nomogram; prognostic.