Clinical Report: Risk Stratification Using Prognostic Inflammatory-Immune Scores
Overview
This study presents a novel Prognostic Inflammatory–Immune Score (PIIS) that improves risk stratification for non-gastric gastrointestinal stromal tumors (GISTs). The integrated model outperformed existing systems in predicting recurrence-free survival and guiding adjuvant therapy duration.
Background
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with non-gastric GISTs exhibiting more aggressive behavior and higher recurrence risks compared to gastric GISTs. Current risk stratification systems, primarily developed from gastric cohorts, have limitations in accurately predicting outcomes for non-gastric GISTs. Therefore, improved prognostic models are essential for optimizing treatment strategies.
Data Highlights
Model
C-index (Training Cohort)
C-index (Validation Cohort)
Integrated Model
0.839
0.795
Key Findings
The PIIS includes the platelet-to-albumin ratio, platelet-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, and lactate dehydrogenase-to-albumin ratio.
Multivariable analysis identified sex, tumor size, mitotic index, Ki-67 index, and PIIS as independent predictors of recurrence-free survival.
The integrated model demonstrated superior discrimination compared to mNIH and AFIP systems.
Risk re-stratification revealed significant heterogeneity within conventional risk categories.
Adjuvant therapy beyond 3 years improved recurrence-free survival in medium- and high-risk subgroups.
Clinical Implications
The developed nomogram may assist clinicians in more accurately predicting recurrence risk in non-gastric GIST patients. This could facilitate more personalized adjuvant therapy planning based on individual risk profiles.
Conclusion
The multicenter-validated nomogram enhances risk prediction for non-gastric GISTs and may serve as a valuable tool for guiding adjuvant therapy decisions.
