Reassessment of the recurrence risk of primary gastrointestinal stromal tumour after complete resection

Abstract

Objectives

The modified National Institutes of Health (NIH) risk criteria for gastrointestinal stromal tumours (GISTs) have some limitations and need to be improved.

Methods

Patients who underwent radical resection of primary GIST were retrospectively reviewed. Peripheral blood indices including the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) were analysed. Recurrence-free survival (RFS) was calculated and compared. Multivariate analysis was conducted. Area under the receiver operating characteristic curve (ROC) was calculated.

Results

A total of 492 patients were enrolled. Tumour size, mitotic index (MI), tumour location and PNI were independent prognostic factors. The modified NIH criteria could not distinguish among very low-, low- and intermediate-risk patients, and PNI was the only independent prognostic factors for them. The five-year RFS rate in the high risk (HR) group was significantly lower. A further modification to the NIH risk criteria was proposed (the ‘NIH-PNI stratification’). Non-high risk (NHR) patients were divided into the NHR-PNI-H group (PNI > 48.05) and the NHR-PNI-L group (PNI ≤ 48.05), respectively. HR patients were divided according to tumour size and MI: the HR1, HR2 and HR3 groups. The five-year RFS rates of the NHR-PNI-H, NHR-PNI-L, HR1, HR2 and HR3 groups were 97.3%, 93.5%, 74.1%, 61.7% and 24.4%, respectively (p < .001). The area under the curve (AUC) for the NIH-PNI stratification, modified NIH criteria, NIH criteria (2002), AFIP criteria and nomogram were 0.857, 0.807, 0.817, 0.843 and 0.831, respectively.

Conclusion

The proposed NIH-PNI stratification was able to distinguish among five groups in terms of risk of recurrence.

Impact statements

A further modification to the NIH risk criteria for GISTs was proposed (‘NIH-PNI stratification’). Non-high risk (NHR) patients were divided into NHR-PNI-H and NHR-PNI-L groups. High risk (HR) patients were divided to HR1, HR2 and HR3 groups. The five-year RFS rates were 97.3%, 93.5%, 74.1%, 61.7% and 24.4%, respectively (p < .001). The AUC for the NIH-PNI stratification, modified NIH criteria, NIH criteria (2002), AFIP criteria and nomogram were 0.857, 0.807, 0.817, 0.843 and 0.831.

Keywords:

• Gastrointestinal stromal tumour
• prognostic nutritional index
• recurrence
• risk assessment
• surgical treatment

Acknowledgments

We owe our thanks to the help and meticulous work of Professor Xiao-dong Teng and Wei Ding in the department of pathology, The First Affiliated Hospital, Zhejiang University School of Medicine.

Author contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by Weili Yang, Chunhui Shou, Zhou Chen, Yanyun Hong, Hang Yu, Xiaodong Wang, Zihan Wu, Qing Zhang, Yuan Gao and Jiren Yu. The first draft of the manuscript was written by Weili Yang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.