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Yang J, Guo P, Zhang Z, Lu C, Qiao Z. The impact of gender on survival outcomes in patients with small intestinal stromal tumors: a comprehensive analysis using the SEER database. Surg Endosc 2024:10.1007/s00464-024-10942-4. [PMID: 38831215 DOI: 10.1007/s00464-024-10942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Small intestinal stromal tumors (SISTs) are a rare type of mesenchymal tumor. Gender is known to influence the incidence and prognosis of various tumors, but its role on the survival of SISTs at the population level remains unclear. Therefore, we aim to explore the relationship between gender and the prognosis of SISTs using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Data on SISTs patients from 2000 to 2019 were derived from the SEER database. Multiple imputation was used to address missing data. Kaplan-Meier analyses and Cox proportional hazard models were applied to evaluate the impact of demographic and clinical characteristics on overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 3513 patients with SISTs were analyzed, including 1921 males and 1592 females. Kaplan-Meier analysis coupled with log-rank testing demonstrated a significantly higher mortality rate among male patients compared to females (P < 0.001). Notably, female patients exhibited superior OS (hazard ratio [HR] 0.808, 95% confidence interval [CI] 0.724-0.902, P < 0.001) and CSS (HR 0.801, 95% CI 0.692-0.927, P = 0.003) compared to male patients. While the mean 1-year CSS rates were comparable between genders (95.3% for males vs. 96.0% for females, P = 0.332), male patients consistently showed lower mean survival rates at 3-, 5-, and 10-year intervals. Surgical intervention significantly boosted 5-year OS and CSS rates in both male and female patients (P < 0.001). Multivariate Cox regression analysis identified age, sex, grade, TNM stage, surgery, and mitotic rate as independent risk factors for OS and CSS in patients with SISTs. CONCLUSIONS Our findings suggest that male patients with SISTs have a higher risk of mortality compared to female patients, indicating that gender may serve as a predictive indicator for survival in this patient population.
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Affiliation(s)
- Jun Yang
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Ping Guo
- Department of Internal Medicine, Dianshan Lake People's Hospital, Suzhou, China
| | - Zhi Zhang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Chengjie Lu
- Department of Traditional Chinese Medicine, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
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Gotohda N, Nishida T, Sato S, Ozaka M, Nakahara Y, Komatsu Y, Kondo M, Cho H, Kurokawa Y, Kitagawa Y. Re-appraisal of the universal definition of tumor rupture among patients with high-risk gastrointestinal stromal tumors. Ann Gastroenterol Surg 2023; 7:1021-1031. [PMID: 37927930 PMCID: PMC10623932 DOI: 10.1002/ags3.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 11/07/2023] Open
Abstract
Aim Tumor rupture has been indicated as a risk factor for recurrence of gastrointestinal stromal tumors (GISTs). The universal definition of tumor rupture was proposed. This study evaluated whether the universal definition was more accurate in identification of GISTs with high recurrent risk than subjective judgment. Methods The study included 507 patients with high-risk GISTs who underwent complete resection between December 2012 and December 2015. We conducted a questionnaire survey in participating institutes to re-diagnose tumor rupture based on the universal definition according to their surgical and pathological findings. We compared the clinical outcomes of tumor rupture based on the definition to those based on the surgeon's judgment and clarified the clinical importance of the rupture. Results Sixty-four patients were initially registered to have tumor rupture by surgeon's judgment, and it became 90 patients who had tumor rupture after reevaluation. Although there were significant differences in recurrence-free survival (RFS) between no rupture and rupture for both initial registration and reevaluation (p = 0.002, <0.001, respectively), a significant difference in overall survival was only observed after reevaluation (p = 0.011). Tumor rupture was significantly associated with large tumor size, mixed cell type in histology, R1 resection, frequent adjuvant therapy and recurrence, but not with location, mitosis, and genotype. Adjuvant therapy more than 3 years improved RFS of patients with tumor rupture. Conclusion This study suggested that tumor rupture based on the universal definition more accurately identified GISTs with poor prognostic outcomes than the subjective judgment.
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Affiliation(s)
- Naoto Gotohda
- Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | | | - Shinsuke Sato
- Department of Gastroenterological SurgeryShizuoka General HospitalShizuokaJapan
| | - Masato Ozaka
- Department of Hepato‐Biliary‐Pancreatic Medicine, Gastroenterology CenterCancer Institute Hospital Japanese Foundation for Cancer ResearchTokyoJapan
| | - Yujiro Nakahara
- Department of Gastroenterological SurgeryOsaka Police HospitalOsakaJapan
| | - Yoshito Komatsu
- Department of Gastroenterology and HepatologyHokkaido University HospitalHokkaidoJapan
| | - Masato Kondo
- Department of SurgeryKobe City Medical Center General HospitalKobeJapan
| | - Haruhiko Cho
- Department of SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University HospitalTokyoJapan
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Emilsson L, Maret-Ouda J, Ludvigsson JF. Mortality in small bowel cancers and adenomas - A nationwide, population-based matched cohort study. Cancer Epidemiol 2023; 85:102399. [PMID: 37327506 DOI: 10.1016/j.canep.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA), neuroendocrine tumors (NET) and gastrointestinal stromal tumors (GIST) are neoplastic lesions of the small bowel while small bowel adenomas are precursors of SBA. AIM To examine mortality in patients diagnosed with SBA, small bowel adenomas, NET and GIST. METHODS We performed a population-based matched cohort study encompassing all individuals with SBA (n = 2289), adenomas (n = 3700), NET (n = 1884) and GIST (n = 509) in the small bowel diagnosed at any of Sweden's 28 pathology departments between 2000 and 2016 (the "ESPRESSO study"). Each case was matched by sex, age, calendar year and county of residence to up to 5 comparators from the general population. Through Cox regression we estimated hazard ratios (HRs) and 95% confidence intervals (95%CIs) for death and cause-specific death adjusting for education. RESULTS During follow-up until December 31, 2017, 1836 (80%) deaths occurred in SBA patients, 1615 (44%) in adenoma, 866 (46%) in NET and 162 (32%) in GIST patients. This corresponded to incidence rates of 295, 74, 80 and 62/1000 person-years respectively and adjusted HRs of 7.60 (95%CI=6.95-8.31), 2.21 (2.07-2.36), 2.74 (2.50-3.01) and 2.33 (1.90-2.87). Adjustment for education had a substantial impact on the HR for death in SBA but not for other neoplasias. The predominant cause of excess death was cancer in all groups. CONCLUSION This study confirms earlier findings of increased death rates in patients with SBA and NET in a modern study population. We also demonstrate a more than 2-fold increased risk of death in both GIST and the SBA precursor adenoma.
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Affiliation(s)
- Louise Emilsson
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - John Maret-Ouda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Pediatrics, Örebro University Hospital, Sweden; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Nomogram for Predicting Recurrence-Free Survival of Primary Localized Gastrointestinal Stromal Tumor. J Pers Med 2023; 13:jpm13030498. [PMID: 36983680 PMCID: PMC10052207 DOI: 10.3390/jpm13030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose: This study aimed to establish a new nomogram that predicts recurrence-free survival (RFS) after a complete surgical resection of primary localized gastrointestinal stromal tumors (GISTs); it also aimed to evaluate the discrimination, calibration, and clinical utility of the decision-making nomogram. Methods: The clinicopathological data of patients with primary localized GISTs at the First Affiliated Hospital of Chongqing Medical University from January 2000 to June 2022 were retrospectively analyzed. The clinicopathological data were randomly split into two sets (7:3 ratio) for training and validation. Suitable variables for the construction of a nomogram for the 1-, 3-, and 5-year RFS were selected using univariate and multivariate Cox regression analyses. Receiver operating characteristic (ROC) analysis and a concordance index (C-index) were used to quantify the discrimination of the nomogram and were compared with four commonly used prognostic scoring systems: Memorial Sloan Kettering Cancer Center prognostic nomogram, National Institutes of Health–Fletcher staging system, Chen’s prognostic nomogram, and Air Forces Institute of Pathology risk criteria–Miettinen staging system. The calibration and clinical utility for the decision-making nomogram were validated using calibration curves and decision curves, respectively. Results: In total, 641 patients were screened and analyzed in this retrospective, observational study. RFS was significantly related to tumor size, mitotic count, gender, DOG-1, and adjuvant therapy with imatinib according to the results of the multivariate and univariate Cox analyses. The nomogram was constructed using the above variables (all p < 0.05) for the 1-, 3-, and 5-year RFS. In the training set, the 1-, 3-, and 5-year ROC and C-index values of the nomogram were 0.868, 0.838, 0.816, and 0.830, respectively. For internal validation, we performed model fitting on the validation set, and the 1-, 3-, and 5-year ROC and C-indices were 0.977, 0.845, 0.869, and 0.849, respectively. Among the five GIST prognostic scoring systems, our nomogram had almost all the largest area under these decision curves and had a good calibration capability. Conclusions: The newly constructed nomogram based on tumor size, gender, mitotic count, DOG-1, and adjuvant treatment with imatinib exhibited an excellent performance and may serve as a prognostic scoring system to support therapeutic decision-making and individualized treatment for GISTs in China.
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Paramythiotis D, Kyriakidis F, Karlafti E, Koletsa T, Tsakona A, Papalexis P, Ioannidis A, Malliou P, Netta S, Michalopoulos A. A Rare Case of Multiple Gastrointestinal Stromal Tumors Coexisting with a Rectal Adenocarcinoma in a Patient with Attenuated Familial Adenomatous Polyposis Syndrome and a Mini Review of the Literature. Medicina (B Aires) 2022; 58:medicina58081116. [PMID: 36013583 PMCID: PMC9415979 DOI: 10.3390/medicina58081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Multiple gastrointestinal stromal tumors (GISTs) are extremely rare entities that exist either as spontaneous GISTs or as part of various syndromes, such as Carney’s triad and type I neurofibromatosis (NF1). Attenuated familial adenomatous polyposis (AFAP) is a variant of familial adenomatous polyposis (FAP) with a milder clinical presentation. Both GISTs and AFAP have been reported to coexist with colorectal cancer, but the coexistence of GISTs and AFAP has never been reported in the literature before. Case report: A 45-year-old male patient with known AFAP arrived scheduled for a total colectomy and ileo-rectal anastomosis due to the malignancy of one of the previously biopsied polyps of the upper rectum. Intraoperatively, multiple nodular tumors were found at the jejunum within a length of 45 cm, for which an enterectomy and enteroanastomosis were performed. A histopathological examination of the whole colectomy specimen confirmed the presence of multiple polyps in the large intestine along with a rectal invasive adenocarcinoma. At the same time, in the examined part of the small intestine, 15 GISTs sized from 0.5 to 2.0 cm of prognostic group I, were identified. The patient’s postoperative course was uncomplicated. Conclusion: Multiple GISTs may present as an asymptomatic disease, and the same thing is true for colorectal cancer. Therefore, the appropriate screening is crucial for entities such as AFAP, since the surgery was performed because of the malignant transformation in one of the polyps and revealed multiple GISTs, as well.
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Affiliation(s)
- Daniel Paramythiotis
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54621 Thessaloniki, Greece
| | - Filippos Kyriakidis
- Second Chemotherapy Department, Theagenio Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece
- Correspondence: (F.K.); (E.K.); Tel.: +30-69-8499-6573 (F.K.)
| | - Eleni Karlafti
- Emergency Department, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
- Correspondence: (F.K.); (E.K.); Tel.: +30-69-8499-6573 (F.K.)
| | - Triantafyllia Koletsa
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Anastasia Tsakona
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aristeidis Ioannidis
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54621 Thessaloniki, Greece
| | - Petra Malliou
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54621 Thessaloniki, Greece
| | - Smaro Netta
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54621 Thessaloniki, Greece
| | - Antonios Michalopoulos
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54621 Thessaloniki, Greece
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SegChaNet: A Novel Model for Lung Cancer Segmentation in CT Scans. Appl Bionics Biomech 2022; 2022:1139587. [PMID: 35607427 PMCID: PMC9124150 DOI: 10.1155/2022/1139587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Accurate lung tumor identification is crucial for radiation treatment planning. Due to the low contrast of the lung tumor in computed tomography (CT) images, segmentation of the tumor in CT images is challenging. This paper effectively integrates the U-Net with the channel attention module (CAM) to segment the malignant lung area from the surrounding chest region. The SegChaNet method encodes CT slices of the input lung into feature maps utilizing the trail of encoders. Finally, we explicitly developed a multiscale, dense-feature extraction module to extract multiscale features from the collection of encoded feature maps. We have identified the segmentation map of the lungs by employing the decoders and compared SegChaNet with the state-of-the-art. The model has learned the dense-feature extraction in lung abnormalities, while iterative downsampling followed by iterative upsampling causes the network to remain invariant to the size of the dense abnormality. Experimental results show that the proposed method is accurate and efficient and directly provides explicit lung regions in complex circumstances without postprocessing.
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Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study. JOURNAL OF ONCOLOGY 2021; 2021:1460131. [PMID: 34938335 PMCID: PMC8687840 DOI: 10.1155/2021/1460131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022]
Abstract
Objective This study aimed to compare the tumor characteristics and long-term outcomes between EGIST and GIST. The confounding function was applied to improve the result credibility in the case of small sample size. Design, Setting, and Participants. This cohort study enrolled 55 patients with EGIST who underwent surgery and were selected from four high-volume hospitals in China and 221 GIST patients who were collected from one of the four hospitals between January 2006 and September 2017. We used propensity score matching (PSM) and subgroup analysis to compare EGIST with GIST in terms of prognosis. The confounding function was used for sensitivity analysis to reduce unmeasured confounding. Results We matched 43 patients in each of the GIST and EGIST groups by PSM. We compared EGIST data with GIST data to explore the prognostic factors between them. In the multivariate Cox regression model, tumor location of EGIST was negatively correlated with overall survival (after PSM: HR, 4.32; 95% CI, 1.22–15.26) or disease-free survival (after PSM: HR, 9.79; 95% CI, 2.22–43.31), which was also intuitively shown in the Kaplan–Meier survival curves (all P values < 0.05). In the subgroup analysis, EGIST with high risk factors had a worse prognosis than GIST. In unmeasured confounding analysis, the overall curve tends to show all combinations of c(0) of c(1) up to 2.0, none of which would bring the corrected relative risk to 1 for OS and DFS. Conclusions and Relevance. EGIST was associated with worse prognosis compared with GIST patients, particularly in EGIST patients with high risk factors, while there was a similar prognosis without those high risk factors.
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Yang CW, Liu XJ, Zhao L, Che F, Yin Y, Chen HJ, Zhang B, Wu M, Song B. Preoperative prediction of gastrointestinal stromal tumors with high Ki-67 proliferation index based on CT features. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1556. [PMID: 34790762 PMCID: PMC8576677 DOI: 10.21037/atm-21-4669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/13/2021] [Indexed: 02/05/2023]
Abstract
Background To determine whether preoperative computed tomography (CT) features can be used for the prediction of gastrointestinal stromal tumors (GISTs) with a high Ki-67 proliferation index (Ki-67 PI). Methods A total of 198 patients with surgically and pathologically proven GISTs were retrospectively included. All GISTs were divided into a low Ki-67 PI group (<10%) and a high Ki-67 PI group (≥10%). All imaging features were blindly interpreted by two radiologists. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive performance of the imaging features. Results Imaging features were found to be significantly different between the low and the high Ki-67 PI groups (P<0.05). Wall thickness of necrosis showed the highest predictive ability, with an area under the curve (AUC) of 0.838 [95% confidence interval (CI): 0.627–0.957], followed by necrosis, necrosis degree, hyperenhancement of the overlying mucosa (HYOM), and long diameter (LD) (AUC >0.7, P<0.05). HYOM was the strongest predictive feature for the high Ki-67 PI GISTs group, with an odds ratio (OR) value of 30.037 (95% CI: 5.707–158.106). Conclusions Imaging features, including the presence of necrosis, high necrosis degree, thick wall of necrosis, and HYOM were significant predictive indicators for the high Ki-67 PI GISTs group.
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Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Zhao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Jiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Clinic Medical Center, Dazhou Central Hospital, Dazhou, China.,Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, CA, USA
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Wu H, Li C, Li H, Shang L, Jing HY, Liu J, Fang Z, Du FY, Liu Y, Fu MD, Jiang KW, Li LP. Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis. World J Gastroenterol 2021; 27:6128-6141. [PMID: 34629824 PMCID: PMC8476333 DOI: 10.3748/wjg.v27.i36.6128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple gastrointestinal stromal tumors (MGISTs) are specific and rare. Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors (GIST). The diagnosis, treatment and follow-up strategies of MGISTs is not specifically described in guidelines.
AIM To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs (SGISTs)
METHODS Patients diagnosed with primary GISTs from March 2010 to January 2020 were included. Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes, propensity score matching was performed according to comorbidities, body mass index, tumor location, mitotic index, sex, age and American Society of Anesthesiologists score. Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.
RESULTS Among the entire cohort of 983 patients, the incidence of MGISTs was 4.17%. Before matching, patients with MGISTs and those with SGISTs had disparities in body mass index, surgical approach, tumor size and mitotic index. After 1:4 ratio matching, the clinical baseline data were comparable. The 5-year progression-free survival rate was 52.17% in the MGIST group and 75.00% in the SGIST group (P = 0.031). On multivariate analysis, tumor location, tumor size, mitotic index, imatinib treatment and MGISTs (hazard ratio = 2.431, 95% confidence interval = 1.097-5.386, P = 0.029) were identified as independent prognostic factors of progression-free survival. However, overall survival was similar between the SGIST and MGIST groups.
CONCLUSION Patients with MGISTs had poorer progression-free survival than patients with SGISTs. Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.
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Affiliation(s)
- Hao Wu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Chen Li
- Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Han Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Liang Shang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Department of Digestive Tumor Translational Medicine, Engineering Laboratory of Shandong Province, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
| | - Hai-Yan Jing
- Department of Pathology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Jin Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Zhen Fang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Feng-Ying Du
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Yang Liu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Meng-Di Fu
- Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Le-Ping Li
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Department of Digestive Tumor Translational Medicine, Engineering Laboratory of Shandong Province, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
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Peng G, Huang B, Yang X, Pang M, Li N. Preoperative CT feature of incomplete overlying enhancing mucosa as a high-risk predictor in gastrointestinal stromal tumors of the stomach. Eur Radiol 2020; 31:3276-3285. [PMID: 33125563 DOI: 10.1007/s00330-020-07377-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether the CT finding of overlying enhancing gastric mucosa (OEGM) can be used to predict risk stratifications by observing CT features of gastrointestinal stromal tumors (GISTs) of the stomach. METHODS Clinical characteristics and CT features within pathologically demonstrated GISTs were retrospectively reviewed. Risk stratifications were classified into non-high group and high-risk group according to the modified National Institutes of Health criteria. Univariate analysis and multivariate logistic regression analysis were performed in order to determine significant predictors for high-risk stratification. Receiver operating characteristic (ROC) curve analysis, subgroup analysis, and pathologic-radiologic correlation analysis were all executed. RESULTS A total of 147 patients were finally enrolled as test subjects. Within the univariate analysis, high-risk tumors tended to have a larger diameter, irregular shape, exophytic growth pattern, present necrosis, incomplete OEGM, tumor vessels, heterogeneous enhancement, and present rupture. According to ROC curve analysis, incomplete OEGM showed the largest area under curve values for diagnosing lesions (0.835; 95% CI, 0.766-0.904; p < 0.001). Multivariate analysis showed that the incomplete OEGM was the strongest independent predictor for high-risk stratification of gastric GISTs (OR = 21.944; 95% CI, 4.344-110.863; p < 0.001). Within the subgroup analysis, incomplete OEGM was more frequently associated with tumors size > 10 cm, irregular shape, exophytic growth pattern, high mitotic count, and disrupted mucosa on pathology. CONCLUSIONS The CT feature of incomplete OEGM is an independent predictive factor for high-risk stratification of gastric GISTs and strongly correlated with pathological mucosal changes. KEY POINTS • Preoperative CT features can be helpful in assessment of risk stratifications of gastric GISTs. • OEGM is an independent predictor for high-risk stratification of gastric GISTs. • Incomplete OEGM likely indicates high-risk stratification of gastric GISTs.
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Affiliation(s)
- Gang Peng
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Bingcang Huang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Xiaodan Yang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Maohua Pang
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Na Li
- Department of Ultrasound and Radiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Road, Saertu District, Daqing, 163000, Heilongjiang, China.
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11
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Li R, Song S, He X, Shi X, Sun Z, Li Z, Song J. Relationship Between Fibrinogen to Albumin Ratio and Prognosis of Gastrointestinal Stromal Tumors: A Retrospective Cohort Study. Cancer Manag Res 2020; 12:8643-8651. [PMID: 32982455 PMCID: PMC7509338 DOI: 10.2147/cmar.s271171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/26/2020] [Indexed: 12/26/2022] Open
Abstract
Objective The fibrinogen to albumin ratio (FAR) is an important parameter that reflects the coagulation state, systemic inflammation, and nutritional status of a patient and plays an essential role in tumor progression. Here, we evaluate the prognostic significance of FAR in gastrointestinal stromal tumor (GIST) patients that underwent radical surgery. Methods We retrospectively analyzed the data of 227 GIST patients that underwent radical surgery in Beijing Hospital from October 2004 to July 2018. We drew a curve of receiver operating characteristics to confirm the optimal critical values for hemoglobin (Hb), prognostic nutrition index (PNI), and FAR. Cox regression analysis and the Kaplan–Meier method were used to assess the prognostic factors. Results The FAR optimal critical value for postoperative recurrence-free survival (RFS) was 0.09. Many significant factors, including approach, the location and size of the tumor, mitotic index, risk classification, Hb levels, PNI, and recurrence, affect FAR. Multivariate analysis indicated that for patients with GISTs who underwent surgery, the tumor location (hazard ratio [HR]=3.393, 95% confidence interval [CI]: 1.539–7.479, P=0.002), mitotic index (HR=4.788, 95% CI: 1.836–12.486, P=0.001), tumor rupture (HR=10.954, 95% CI: 2.170–55.296, P=0.004), and FAR (HR=3.093, 95% CI: 1.303–7.339, P=0.010) were independent factors affecting RFS. Moreover, the FAR remained of prognostic significance for GIST stratified by subgroup analysis. Conclusion Preoperative FAR is a reliable marker for evaluating the prognosis of GIST, the prognostic ability of FAR is significantly better than Hb and PNI.
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Affiliation(s)
- Rui Li
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
| | - Shibo Song
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, People's Republic of China
| | - Xiuwen He
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
| | - Xiaolei Shi
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
| | - Zhen Sun
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
| | - Zhe Li
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Peking University Fifth School of Clinical Medicine, Beijing 100730, People's Republic of China
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12
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Rong J, Chen S, Song C, Wang H, Zhao Q, Zhao R, He Y, Yan L, Song Y, Wang F, Xie Y. The prognostic value of gender in gastric gastrointestinal stromal tumors: a propensity score matching analysis. Biol Sex Differ 2020; 11:43. [PMID: 32703269 PMCID: PMC7376864 DOI: 10.1186/s13293-020-00321-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) of the stomach are the most common GISTs. The risk, incidence, and outcome of cancer are different between the sexes. Whether gender is related to the prognosis of gastric stromal tumors is unclear. Therefore, this study aims to explore the relationship between gender and gastric GIST prognosis. Methods Data from gastric GIST patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce confounding factors, and the clinicopathological features and prognosis of GIST patients were comprehensively evaluated. Results There were 512 male patients and 538 female patients with gastric GIST. The gender of gastric GIST patients was associated with marital status, surgical treatment, tumor size, and mitotic index (P < 0.05). The Kaplan-Meier analysis and log-rank test revealed that male patients had a higher mortality rate than female patients (P = 0.0024). After matching all the potential confounding factors, the survival of the female gastric GIST patients was better than that of the male gastric GIST patients (P = 0.042). Cox regression analysis revealed that gender was an independent risk factor for overall survival. The risk of death was higher for males than for females (HR 1.677, 95% CI 1.150–2.444, P = 0.007). Conclusion Gender could be a prognostic factor for gastric GIST survival, and male patients had a higher risk of death.
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Affiliation(s)
- Jianfang Rong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Sihai Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Conghua Song
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.,Department of Gastroenterology, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Huan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Qiaoyun Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Rulin Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Yajing He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Lili Yan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.,School of Pharmacy, Nanchang University, Nanchang, China
| | - Yanping Song
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Fangfei Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China.,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China.,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Yong Xie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi Province, China. .,Gastroenterology Institute of Jiangxi Province, Nanchang, Jiangxi Province, China. .,Key Laboratory of Digestive Diseases of Jiangxi Province, Nanchang, Jiangxi Province, China.
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