Research Paper Volume 12, Issue 12 pp 11416—11430

Comparison of prognostic prediction models for rectal gastrointestinal stromal tumor

Liu Jiaxin1,2, *, , Zhou Peiyun3, *, , Tang Zheng3, *, , Yuan Wei1, , Shen Shanshan1, , Ren Lei1, , Xing Zhengwen1, , Fang Yong4, , Gao Xiaodong4, , Xue Anwei4, , Shen Kuntang4, , Hou Yingyong1, ,

  • 1 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
  • 2 Shanghai Chest Hospital, Shanghai Jiao Tong University, Department of Pathology, Shanghai, China
  • 3 Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
  • 4 Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
* Equal contribution

Received: December 16, 2019       Accepted: April 17, 2020       Published: June 20, 2020
How to Cite

Copyright © 2020 Jiaxin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Rectal gastrointestinal stromal tumors (RGISTs) are biologically characterized tumors that are relatively rare. Thus, few studies have reported a specific prognostic system for this subset of tumors but integrated it into parallel systems, such as small intestine. Our aim is to develop a new predictive staging system nomogram (named FD-ZS system) for RGISTs.

Results: Tumor size and mitotic rate were independent risk factors for tumor recurrence in RGISTs according to univariate and multivariate survival analyses. A prognostic predictive nomogram was developed, and a cut-off value of 65 points was calculated by X-tile to discriminate risk based on tumor size and mitotic rate. The C-indices for the FD-ZS, FD-Hou, NIH, and WHO systems were 0.706, 0.693, 0.687, and 0.680, respectively.

Conclusion: In the present study, a concise two-tier grading system (FD-ZS) for prognostic prediction of RGISTs that is simpler to several reported systems was developed, and a cut-off value was established to help RGIST patients determine whether to undergo adjuvant imatinib treatment.

Methods: A nomogram was employed, and its predictive accuracy and discriminative ability were determined by concordance index (C-index) and calibration curve analyses. The nomogram was then compared with three stratification systems used for GISTs (FD-Hou, NIH, and WHO).


GIST: gastrointestinal stromal tumors; RGIST: rectal GIST; IM: imatinib; OS: overall survival; RFS: recurrence-free survival; NIH: the modified National Institutes of Health; WHO: the WHO Classification of Tumors of the Digestive System; PDGFRA: platelet-derived growth factor receptor alpha; HPFs: high-power microscopic fields.