Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data
Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data
复制标题
胃胃肠道间质瘤内镜切除难度的预测因素及随访数据。
DOI：
10.1111/jgh.15650
复制
发表时间：
2021-08-16
影响因子：
4.1
通讯作者：
Zhou, Pinghong
中科院分区：
文献类型：
--
作者：
Su, Wei;Wang, Min;Zhou, Pinghong
背景与目的胃肠道间质瘤(GIST)是胃最常见的黏膜下肿瘤，需要治疗干预。我们的目标是确定胃镜下胃肠道间质瘤切除术中技术难度的预测因素，并调查随访结果。方法回顾分析2009年6月至2020年6月中山医院收治的胃肠道间质瘤患者的临床资料。收集和分析临床和病理特征、内窥镜操作信息和随访数据。编制了一份诺模图，并在内部和外部进行了验证。结果共分析了628例胃肠道间质瘤。66例患者出现上述困难。鼻甲大小(2~3 cm：或2.431，P=0.018；P=9.765；P；t；0.001)，黏膜下侵犯深度(MP：或2.280，P=0.038，MP-EX：或4.295，P=0.002)和缺乏经验(OR 2.075，P=0.016)是手术困难的独立危险因素。诺模图预测模型显示，经偏差校正的C指数值为0.778，外部验证队列的曲线下面积(AUC值)为0.756。以0.15为界值，诺模图对非难治性GIST的阴性预测值(NPV)和准确度(ACC)分别为94.9%和79.8%。随访结果显示，仅5例胃肠道间质瘤患者在内窥镜下切除后局部复发。结论肿瘤大小、侵袭深度和内窥镜医师的经验是影响胃镜下胃肠道间质瘤切除困难的危险因素。我们的诺模图为筛选非困难的GIST切除提供了一个有价值的工具。
Background and Aim Gastrointestinal stromal tumors (GISTs) are among the most common submucosal tumors in the stomach that require therapeutic intervention. We aim to identify the predictors of technical difficulty during endoscopic resection of gastric GIST and to investigate follow-up outcomes. Methods Patients with gastric GISTs were reviewed from June 2009 to June 2020 at Zhongshan Hospital. Clinical and pathological features, endoscopic procedure information, and follow-up data were collected and analyzed. A nomogram was developed and validated internally and externally. Results A total of 628 GISTs were finally analyzed. The difficulty was experienced in 66 cases. GISTs size (2-3 cm: OR 2.431 P = 0.018 and > 3 cm: OR 9.765 P < 0.001), invasion depth beyond submucosal (MP: OR 2.280, P = 0.038 and MP-ex: OR 4.295, P = 0.002), and lack of experience (OR 2.075, P = 0.016) were independent risk factors of difficulty. The nomogram prediction model showed a bias-corrected C-index value of 0.778 and acquired an area under curve (AUC) of 0.756 on the external validation cohort. At the cut-off of 0.15, the nomogram's negative predictive value (NPV) and accuracy (ACC) were 94.9% and 79.8% in identifying non-difficult GISTs. Follow-up results showed that only five GIST patients had local recurrence after endoscopic resection. Conclusions Tumor size, invasion depth, and endoscopists' experience were risk factors for the difficulty of endoscopic GIST resection. Our nomogram provided a valuable tool for screening non-difficult GIST resection.