P-O06 A scoring system to support surgical decision-making for cardial submucosal tumors

Abstract

Abstract Background Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system to help clinicians make surgical decisions for cardial submucosal tumors. Methods A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study. All of them were randomized into the training cohort (n = 147) or internal validation cohort (n = 99). Then, the scoring system was proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort. Results Of 246 patients, 97 were treated with STER, and the others with non-tunneling endoscopic resection. In the training stage, four factors were weighted with points based on the β coefficient from the regression model, including irregular morphology (-2 points), ulcer (2 points), the direction of the gastroscope (-2 points for reversing direction and 1 point for entering direction), and originating from the muscularis propria (-2 points). The patients were categorized into low-score (< -4), medium-score (-4 - -3) and high-score (> -3) groups, and those with low scores were more likely to be treated with STER. Our score model performed satisfying discriminatory power in internal validation (Areas under the receiver-operator characteristic curve (AUC), 0.829; 95% confidence interval (CI), 0.694-0.964) and goodness-of-fit in the Hosmer-Lemeshow test (P = .4721). Conclusions This scoring system could provide clinicians the references for making decisions about the treatment of cardial submucosal tumors.