Assessment of Systemic Inflammation and Nutritional Indicators in Predicting Recurrence-Free Survival After Surgical Resection of Gastrointestinal Stromal Tumors.

Zhenhua Lu,Chengyu Liu,Weiwei Shao,Xianglong Cao,Zhen Sun,Yangyang Zheng,Jinghai Song,Xiaolei Shi,Rui Li

doi:10.3389/fonc.2021.710191

Abstract

BackgroundRecent studies have shown that the systemic inflammation and nutritional indicators are prognostic for a variety of malignancies. However, only limited data have so far demonstrated their usefulness in gastrointestinal mesenchymal tumors (GIST).MethodsWe retrospectively analyzed the data of GIST patients who underwent radical surgery in Beijing hospital from October 2004 to July 2018. The area under the receiver operating characteristic curve (AUC) was used to compare several commonly used inflammatory and nutritional indicators. The indicators with largest AUC were further analysis. Optimal cut-off values of those indicators in predicting recurrence-free survival (RFS) were determined. Kaplan-Meier curve and the time-dependent receiver operating characteristic (ROC) curve were used to assess the prognostic values. We then used univariate and multivariate Cox regression analyses to identify prognostic factors that were associated with RFS.ResultsIn total, 160 patients who underwent surgery for GIST were included in the study. The median survival time was 34.5 months, with 1-, 3-, and 5-year RFS rates of 96.1%, 84.7%, and 80.8%, respectively. The inflammatory and nutritional indicators with largest AUC were Systemic immunoinflammatory Index (SII) and Geriatric Nutrition Risk Index (GNRI), reached 0.650 and 0.713, respectively. The optimal cutoff of GNRI and SII were 98.3, and 820.0, respectively. Univariate analysis showed that GNRI, SII, KI67, surgery method, tumor location, tumor size, and mitotic index were all significant prognostic indicators of RFS. After multivariate Cox analysis, independent prognostic factors for RFS in GIST included tumor location, mitotic index, tumor size, and GNRI (HR=2.802,95% CI: 1.045 to 7.515, p = 0.041). Besides, SII also tended to be associated with RFS (HR = 2.970, 95% CI: 0.946 to 9.326, p = 0.062).ConclusionsHigh GNRI is an independent prognostic factor for RFS in GIST, while SII can be considered as a prognostic factor. GNRI and SII can be used as tools to evaluate the prognosis of patients before surgery, helping doctors to better treat high-risk patients.

Highlights

Gastrointestinal mesenchymal tumor (GIST) is the most common type of sarcoma with a low incidence in the population [1]
The results showed that Geriatric Nutrition Risk Index (GNRI) was the most powerful predictor of the four nutritional risk indexes
GNRI was calculated as GNRI = [1.489* albumin (g/L)] + [41.7*] and ideal weight was calculated from the Lorentz equations (WLo) [31], and when weight > ideal weight, the ratio was treated as 1, Systemic Immunoinflammatory Index (SII) is defined as Platelet count × Neutrophil count/Lymphocyte count, NLR is defined as neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio (LMR) is defined as lymphocytemonocyte ratio, Prognostic Nutritional Index (PNI) is defined as 10×serum albumin value (g/ dL)+0.005×peripheral lymphocyte count, BMI is defined as height/weight/weight

Summary

Introduction

Gastrointestinal mesenchymal tumor (GIST) is the most common type of sarcoma with a low incidence in the population [1]. It is believed that GIST mainly occurs from Interstitial cells of Cajal (ICC), the cells that trigger gastrointestinal motility, most commonly due to mutations in the receptor tyrosine kinase, especially in adults with mutations in the KIT or PDGFRA genes [6,7,8]. These mutations lead to constitutive activation of tyrosine kinases and are the basis for targeted molecular therapies. Only limited data have so far demonstrated their usefulness in gastrointestinal mesenchymal tumors (GIST)

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