A multivariate prediction model for high malignancy potential gastric GI stromal tumors before endoscopic resection
A multivariate prediction model for high malignancy potential gastric GI stromal tumors before endoscopic resection
复制标题
内镜切除前高恶性潜能胃胃肠道间质瘤的多变量预测模型
DOI：
10.1016/j.gie.2019.09.032
复制
发表时间：
2020-04-01
影响因子：
7.7
通讯作者：
Han, Ying
中科院分区：
文献类型：
--
作者：
Yang, Ze;Gao, Yuan;Han, Ying
背景和目的：内镜切除术正在成为治疗胃胃肠道间质瘤（GIST）的一种选择。尽管尚未达成共识，但具有高恶性潜力的 GIST 患者通常被认为是手术候选者。然而，尚未制定系统的术前评估策略。本研究旨在开发术前多变量模型来预测胃 GIST 的恶性潜力。方法：本研究分为 2 个阶段。首先，在回顾性队列中使用多变量逻辑回归分析开发了小于 5 cm 胃 GIST 的多变量预测模型。接下来，该预测模型在胃 GIST 验证队列中得到进一步验证。结果：在开发阶段，纳入了 275 名患者。多变量分析表明，小于 5 cm 的高恶性潜能胃 GIST 的独立危险因素是肿瘤大小 >= 2 cm（根据截断值）、肿瘤形状不规则和粘膜溃疡 (P < .05)。根据相应的回归系数，对3个危险因素进行分值加权：粘膜溃疡1分，肿瘤形状不规则2分，肿瘤大小>=2cm3分。在验证阶段，纳入了 186 名患者。预测模型的曲线下面积为0.80（95%置信区间，0.73-0.85），显着高于仅考虑肿瘤大小的曲线下面积（P=0.034）。结论：小于5cm的高恶性潜在胃GIST的独立危险因素是肿瘤大小大于2cm、肿瘤形状不规则和粘膜溃疡。这些因素可以通过简单的组合来预测胃胃肠道间质瘤的恶性潜力。
Background and Aims: Endoscopic resection is becoming an option in the management of gastric GI stromal tumors (GISTs). Although no consensus has been reached, patients with high malignancy potential GISTs are generally considered to be surgical candidates. However, no systematic preoperative evaluation strategy has yet been developed. The current study was performed to develop a preoperative multivariate model to predict the malignant potential of gastric GISTs.Methods: This study consisted of 2 stages. First, a multivariate prediction model for gastric GISTs smaller than 5 cm was developed using a multivariate logistic regression analysis in a retrospective cohort. Next, the prediction model was validated further in a validation cohort of gastric GISTs.Results: In the developing stage, 275 patients were included. The multivariate analysis demonstrated that independent risk factors for high malignancy potential gastric GISTs smaller than 5 cm were tumor size >= 2 cm (according to cutoff value), an irregular tumor shape, and mucosal ulceration (P < .05). Based on accordant regression coefficients, 3 risk factors were weighted with point values: 1 point for mucosal ulceration, 2 points for an irregular tumor shape, and 3 points for tumor size >= 2 cm. In the validation stage, 186 patients were included. The area under the curve of the prediction model was .80 (95% confidence interval, .73-.85), which was significantly higher than that of tumor size alone (P = .034).Conclusions: The independent risk factors for high malignancy potential gastric GISTs smaller than 5 cm were tumor size larger than 2 cm, an irregular tumor shape, and mucosal ulceration. These factors could be used to predict malignancy potential of gastric GISTs in a simple combination.