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A CT-based nomogram for predicting the malignant potential of primary gastric gastrointestinal stromal tumors preoperatively

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Abstract

Purpose

To develop and validate a computerized tomography (CT)-based nomogram for predicting the malignant potential of primary gastric gastrointestinal stromal tumors (GISTs).

Methods

The primary and validation cohorts consisted of 167 and 39 patients (single center, different time periods) with histologically confirmed primary gastric GISTs. Clinical data and preoperative CT images were reviewed. The association of CT characteristics with malignant potential was analyzed using univariate and stepwise logistic regression analyses. A nomogram based on significant CT findings was developed for predicting malignant potential. The predictive accuracy of the nomogram was determined by the concordance index (C-index) and calibration curves. External validation was performed with the validation cohort.

Results

CT imaging features including tumor size, tumor location, tumor necrosis, growth pattern, ulceration, enlarged vessels feeding or draining the mass (EVFDM), tumor contour, mesenteric fat infiltration, and direct organ invasion showed significant differences between the low- and high-grade malignant potential groups in univariate analysis (P < 0.05). Only tumor size (> 5 cm vs ≤ 5 cm), location (cardiac/pericardial region vs other), EVFDM, and mesenteric fat infiltration (present vs absent) were significantly associated with high malignant potential in multivariate logistic regression analysis. Incorporating these four independent factors into the nomogram model achieved good C-indexes of 0.946 (95% confidence interval [CI] 0.899–0.975) and 0.952 (95% CI 0.913–0.977) in the primary and validation cohorts, respectively. The cutoff point was 0.33, with sensitivity, specificity, and diagnostic accuracy of 0.865, 0.915, and 0.780, respectively.

Discussion

Primary gastric GISTs originating in the cardiac/pericardial region appear to be associated with higher malignant potential. The nomogram consisting of CT features, including size, location, EVFDM, and mesenteric fat infiltration, could be used to accurately predict the high malignant potential of primary gastric GISTs.

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Funding

Funding was provided by National Natural Science Foundation of China (Grant No. 81870451).

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Author notes

  1. Chang Li and Wenhao Fu have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China

    Chang Li, Wenhao Fu, Li Huang, Yingqian Chen, Pei Xiang, Jian Guan & Canhui Sun

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  1. Chang Li
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Correspondence to Jian Guan or Canhui Sun.

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Li, C., Fu, W., Huang, L. et al. A CT-based nomogram for predicting the malignant potential of primary gastric gastrointestinal stromal tumors preoperatively. Abdom Radiol 46, 3075–3085 (2021). https://doi.org/10.1007/s00261-021-03026-7

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