Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2019; 25(10): 1238-1247
Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1238
Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study
Tao Chen, Liang-Ying Ye, Xing-Yu Feng, Hai-Bo Qiu, Peng Zhang, Yi-Xin Luo, Li-Yi Yuan, Xin-Hua Chen, Yan-Feng Hu, Hao Liu, Yong Li, Kai-Xiong Tao, Jiang Yu, Guo-Xin Li
Tao Chen, Yi-Xin Luo, Li-Yi Yuan, Xin-Hua Chen, Yan-Feng Hu, Hao Liu, Jiang Yu, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Liang-Ying Ye, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Xing-Yu Feng, Yong Li, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Hai-Bo Qiu, Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
Peng Zhang, Kai-Xiong Tao, Department of General Surgery, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Chen T, Ye LY, Feng XY, Qiu HB, Zhang P, Li Y, Tao KX, and Li GX designed the research; Chen T, Luo YX, Yuan LY, Chen XH, and Yu J performed the research; Hu YF and Liu H contributed new reagents/analytic tools; all authors wrote the paper.
Supported by the State Key Project of Research and Development Plan, No. 2017YFC0108300 and No. 2017YFC0108303; and 2018 Special Funds for the Cultivation of Guangdong College Students' Scientific and Technological Innovation (Climbing Program Special Funds), No. pdjha0094.
Institutional review board statement: The study was approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Guo-Xin Li, FRCS (Gen Surg), MD, PhD, Professor, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China.
Telephone: +86-20-61411681 Fax: +86-20-62787626
Received: November 12, 2018
Peer-review started: November 12, 2018
First decision: December 12, 2019
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 16, 2019
Published online: March 14, 2019
Research background

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor type in the gastrointestinal (GI) system. Presently, various classification systems to prognosticate GISTs have been proposed.

Research motivation

It is unknown which classification system is more accurate when predicting the prognosis of patient with GISTs. This study will help doctors decide when considering the frequency of reexamination and whether to take a tyrosine kinase inhibitor.

Research objectives

The aim of this study was to evaluate the application value of four different risk stratification systems for GISTs.

Research methods

Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health (NIH) criteria, the Armed Forces Institute of Pathology (AFIP) criteria, the Memorial Sloan Kettering Cancer Center (MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic (ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve (AUC).

Research results

According to the ROC curve, the AFIP criteria showed the largest AUC (0.754).

Research conclusions

According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.

Research perspectives

The study evaluated the application value of four different risk stratification systems for GISTs and found that the AFIP criteria have better accuracy in clinical application. Due to the imperfection of China's follow-up system and the particularity of its medical system, there may be some bias in this data. In the future, we will improve the follow-up mechanism to ensure the accuracy of data, and prospective studies may bring more accurate results.