Abstract
Background
The effect of surgical resection on the long-term outcome of GIST patients with initially
diagnosed synchronous hepatic metastases in the targeted therapy era is still uncertain.
The main aims of this study were to investigate the role of surgery in the treatment
of these patients and establish clinical predictive models for assessing prognosis.
Methods
We identified these patients from the Surveillance, Epidemiology and End Results (SEER)
database between 2010 and 2018. The selection bias in comparisons was minimized by
performing propensity score matching (PSM). The risk factors associated with long-term
survival outcomes were identified by a Cox proportional hazards model and thus used
to establish the nomograms. Nomograms were validated by concordance indexes (C-indexes),
time-dependent receiver operator characteristic (ROC) curves, calibration plots, and
decision curve analyses (DCA).
Results
Of these 523 eligible patients, there were 187 (35.8%) and 336 (64.2%) patients in
the surgical and nonsurgical groups, respectively. Multivariate analysis revealed
that surgical resection was an independent prognostic factor for OS (hazard ratio
[HR] 0.62; 95% confidence interval [CI] 0.44–0.88, p = 0.0068) and CSS (HR 0.51; 95% CI 0.33 - 0.77, p = 0.0016). After PSM, it was found that surgical resection still showed significantly
improved OS (5-year 54.9% vs 38.8%, p = 0.028) and CSS (5-year 65.8% vs 50.3%, p = 0.077). In addition, the C-indexes of the nomograms for OS and CSS prediction were
0.692 and 0.705, respectively, and the nomograms showed good consistency.
Conclusion
This study revealed that surgical resection has a favorable impact on the long-term
outcome of patients with synchronous GIST liver metastases, and the nomograms showed
remarkable prediction performance for OS and CSS.
Keywords
Abbreviations:
GIST (gastrointestinal stromal tumor), SEER (the Surveillance, Epidemiology and End Results), PSM (propensity score matching), C-indexes (concordance indexes), ROC (receiver operator characteristic), DCA (decision curve analyses), OS (overall survival), CSS (cancer-specific survival), ICD (the International Classification of Disease), NCCN (the National Comprehensive Cancer Network), SHMs (synchronous hepatic metastases), LMs (liver metastases)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 21, 2022
Accepted:
August 4,
2022
Received:
April 3,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
