Dataset Information

A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors.

ABSTRACT: Our study aimed to establish and validate a multi-class scoring system for preoperative gastric gastrointestinal stromal tumors (GISTs) risk stratifications based on CT features. 150 gastric GIST patients who underwent contrast-enhanced CT examination and surgical resection from hospital 1 were retrospectively analyzed as the training cohort, and 61 patients from hospitals 2 and 3 were included as the validation cohort. A model was established by logistic regression analysis and weighted to be a scoring model. A calibration test, area under the receiver operating characteristic (ROC) curve (AUC), and cutoff points were determined for the score model. The model was also divided into three score ranges for convenient clinical evaluation. Five CT features were included in the score model, including tumor size (4 points), ill-defined margin (6 points), intratumoral enlarged vessels (5 points), heterogeneous enhancement pattern (4 points), and exophytic or mixed growth pattern (2 points). Then, based on the calibration results, performance was merely assessed as very low and high* risk. The AUCs of the score model for very low risk and high* risk were 0.973 and 0.977, and the cutoff points were 3 points (97.30%, 93.81%) and 7 points (92.19%, 94.19%), respectively. In the validation cohort, the AUCs were 0.912 and 0.972, and the cutoff values were 3 points (92.31%, 85.42%) and 5 points (100%, 87.88%), respectively. The model was stratified into 3 ranges: 0-3 points for very low risk, 4-8 points for low risk, and 9-21 points for high* risk. A concise and practical score system for gastric GISTs risk stratification was proposed.

SUBMITTER: Xu J

PROVIDER: S-EPMC7716157 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors.

Xu Jianxia J Zhou Jiaping J Wang Xiaojie X Fan Shufeng S Huang Xiaoshan X Xie Xingwu X Yu Risheng R

American journal of cancer research 20201101 11

Our study aimed to establish and validate a multi-class scoring system for preoperative gastric gastrointestinal stromal tumors (GISTs) risk stratifications based on CT features. 150 gastric GIST patients who underwent contrast-enhanced CT examination and surgical resection from hospital 1 were retrospectively analyzed as the training cohort, and 61 patients from hospitals 2 and 3 were included as the validation cohort. A model was established by logistic regression analysis and weighted to be a ...[more]

PMID: 33294273

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Project description:Gastrointestinal stromal tumors (GIST) are rare mesenchymal smooth muscle sarcomas that can arise anywhere within the gastrointestinal tract. Sporadic mutations within the tyrosine kinase receptors of the interstitial cells of Cajal have been identified as the key molecular step in GIST carcinogenesis. Although many patients are asymptomatic, the most common associated symptoms include: abdominal pain, dyspepsia, gastric outlet obstruction, and anorexia. Rarely, GIST can perforate causing life-threatening hemoperitoneum. Most are ultimately diagnosed on cross-sectional imaging studies (i.e., computed tomography and/or magnetic resonance imaging in combination with upper endoscopy. Endoscopic ultrasonographic localization of these tumors within the smooth muscle layer and acquisition of neoplastic spindle cells harboring mutations in the c-KIT gene is pathognomonic. Curative treatment requires a complete gross resection of the tumor. Both open and minimally invasive operations have been shown to reduce recurrence rates and improve long-term survival. While there is considerable debate over whether GIST can be benign neoplasms, we believe that all GIST have malignant potential, but vary in their propensity to recur after resection and metastasize to distant organ sites. Prognostic factors include location, size (i.e., > 5 cm), grade (> 5-10 mitoses per 50 high power fields and specific mutational events that are still being defined. Adjuvant therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to reduce the risk of recurrence after one year of therapy. Treatment of locally-advanced or borderline resectable gastric GIST with neoadjuvant imatinib has been shown to induce regression in a minority of patients and stabilization in the majority of cases. This treatment strategy potentially reduces the need for more extensive surgical resections and increases the number of patients eligible for curative therapy. The modern surgical treatment of gastric GIST combines the novel use of targeted therapy and aggressive minimally invasive surgical procedures to provide effective treatment for this lethal, but rare gastrointestinal malignancy.

Project description:Early detection of gastrointestinal stromal tumor (GIST) liver metastases is crucial for the management and prognosis. In our experience, GIST liver metastases can display hypermetabolism on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and marked enhancement on magnetic resonance imaging (MRI), which are uncommon in other tumors before treatment. Most literature focus on the imaging evaluation, prognosis after treatment and less is known about imaging features on both imaging methods before treatment. This study analyzes the imaging features of newly diagnosed GIST liver metastases on 18F-FDG PET/CT and MRI, with goal of improving diagnostic accuracy. This retrospective study included 55 patients with pathological or radiographical confirmed GIST liver metastases who underwent PET/CT (n=29), MRI (n=22), or both methods (n=4). PET/CT and MRI interpretation including lesion's morphologic features, number, density or signal intensity, hemorrhage, cystic changes or necrosis, maximum standardized uptake value (SUVmax) of liver metastases and liver background on PET imaging, degree and pattern of enhancement on MRI were obtained by two experienced nuclear medicine physicians and two radiologists respectively. Data are presented as numbers, percentages, means ± standard deviations or median (interquartile range). The correlation between diameter and SUVmax of metastases, and primary tumor SUVmax and synchronous liver metastases SUVmax were analyzed by Spearman's rank test. On PET/CT visual analysis, 38.9%, 23.9%, and 37.2% of lesions showed significant hypermetabolism, slightly higher metabolism, and equal or lower metabolism than liver, respectively. There was a weak correlation between the diameter and SUVmax of liver metastases (rs =0.370, P<0.001), and a moderate correlation between SUVmax of synchronous liver metastases and the primary tumors (rs =0.492, P<0.001). On contrast-enhanced MRI, 90.8% of lesions showed heterogeneous enhancement in the arterial phase with the variable presentation, and 74.3% had different enhancement patterns between margins and intratumoral parenchyma. Liver lesions in GIST displaying significant, slight hypermetabolism on 18F-FDG PET/CT, marked or heterogeneous gradual enhancement within the intratumoral parenchyma with ring-like enhancement on MRI may denote the diagnosis of liver metastasis. However, GIST liver metastases may also display equal or lower metabolism than liver parenchyma on PET, making small lesions more difficult to diagnose.

Dataset Information

A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors.

Publications

A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors.

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