AUTHOR=Xu Yuting , Luo Lijie , Feng Xingyu , Zheng Yensheng , Chen Tao , Zhou Rui , Li Yong , Li Guoxin , Wang Wei , Xiong Wenjun 

TITLE=Nomogram for Predicting Risk of Esophagogastric Junction (EGJ) Resection During Laparoscopic Resection of Gastrointestinal Stromal Tumors in EGJ: A Retrospective Multicenter Study

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.712984

DOI=10.3389/fsurg.2021.712984

ISSN=2296-875X

ABSTRACT=<p><bold>Background:</bold> The established criteria for determining whether to excise the cardia during laparoscopic surgery for gastrointestinal stromal tumors in the esophagogastric junction (EGJ-GISTs) remain controversial. This retrospective multicenter study was conducted to develop a nomogram for predicting the risk of the cardia excision during laparoscopic surgery for EGJ-GISTs.</p><p><bold>Material and Methods:</bold> We reviewed data from 2,127 gastric-GISTs (g-GISTs) patients without distant metastases in four hospital between June 2012 and June 2020. Of those, according to the including criteria, 184 patients [Guangdong Provincial Hospital of Chinese Medicine (<italic>n</italic> = 81), Nanfang Hospital of Southern Medical University (<italic>n</italic> = 60), Guangdong General Hospital (<italic>n</italic> = 34), and The Third Affiliated Hospital of Southern Medical University (<italic>n</italic> = 9)] with EGJ-GISTs were identified and included in this study. Factors contributing to risk of cardia excision were identified and used to create a nomogram. Nomogram performance was assessed using a bootstrapped concordance index (c-index) and calibration plots.</p><p><bold>Results:</bold> According to the multivariate analysis, the distance from the margin of the tumor to the esophagogastric line (EG-line) (cm) (<italic>OR</italic> = 0.001, <italic>95% CI</italic>: 0.00001~0.056, <italic>P</italic> = 0.001) and tumor size (cm) (<italic>OR</italic> = 14.969, <italic>95% CI</italic>: 1.876~119.410, <italic>P</italic> = 0.011) were significantly related to likelihood of cardia structure excision in laparoscopic surgery for EGJ-GISTs. These two factors were used to generate a nomogram for predicting risk of cardia excision using a logistic regression model; a bootstrapped <italic>C-index</italic> of 0.988 (calibrated <italic>C-index</italic> = 0.987) indicated strong predictive ability, with broad calibration.</p><p><bold>Conclusions:</bold> This nomogram based on distance from tumor margin to EG-line and tumor size may serve as a tool for predicting risk of cardia damage during laparoscopic removal of EGJ-GISTs to aid in selection of surgical methods and preoperative neoadjuvant therapy.</p>