Distinguishing very high-risk patients among high-risk gastrointestinal stromal tumor cases: development and validation of a nomogram based on a multicenter population-based retrospective cohort study

作者：Qi Jiang, Yang Fu, Xinhua Zhang, Peng Zhang, Zhidong Gao, Jun Zhang, Xuefeng Zhao, Haibo Qiu, Zilong Zhang, Yingfeng Fu, Jianjun Liu, Zhenhua Yang, Bo Zhang, Xiaodong Gao, Kaixiong Tao · 发表于：Annals of Medicine · 年份：2025 · DOI：10.1080/07853890.2025.2520896 · 被引用次数：1 · 研究领域：Gastrointestinal Tumor Research and Treatment、Gastrointestinal disorders and treatments、Gastrointestinal Bleeding Diagnosis and Treatment

BACKGROUND: High-risk gastrointestinal stromal tumors (GISTs) are highly heterogeneous. This study aimed to developa nomogram for predicting recurrence in patients with high-risk GISTand to provide guidance for adjuvant therapy. METHODS: Data were retrospectively collected from 971 patients with high-risk GIST who underwent genetic testingat 13 centers in China. A nomogram was constructed in the training cohort and validated in the validation cohort. RSEULTS: The training and validation cohorts included 696 and 275 patients, respectively. The nomogram incorporated blood plateletlevels, total protein, tumor location, tumor size, mitotic count, tumor rupture, Ki-67 index, and gene mutations. The C-index and AUC were 0.758 and 0.781 in the training cohort and 0.841 and 0.755, respectively, in the validation cohort. Calibration and DCA curves confirmed favorable discrimination, calibration accuracy, and clinical benefits. Using the nomogram, patients were categorized into a general high-risk groupand a very high-risk group. Among the general high-risk group, no significant difference in RFS was observed between patients who received adjuvant imatinib for 2.5 years or longer. Conversely, in the very high-risk group, patients receiving adjuvant imatinib for five or more years had markedly improved RFS. CONCLUSIONS: Based on the largest nomogram-related multicenter study in high-risk GIST, the nomogram accurately predicted RFS in patients with high-risk GIST and provided guidance on...