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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 353-361. doi: 10.19723/j.issn.1671-167X.2020.02.025

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Clinicopathological features and prognosis of colorectal stromal tumor

Wen-peng WANG1,Jie-fu WANG1,Jun HU1,Jun-feng WANG1,Jia LIU1,Da-lu KONG1,△(),Jian LI2   

  1. 1. Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
    2. Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
  • Received:2019-11-18 Online:2020-04-18 Published:2020-04-18
  • Contact: Da-lu KONG E-mail:kongdalu@tjmuch.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81101870);the National Key Clinical Specialty Construction Project(2013-544);the Key Project of Tianjin Health and Family Planning Commission(16kg127)

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Abstract:

Objective: The incidence of colorectal stromal tumor is low among digestive tract tumors, therefore the literatures about clinicopathological features and prognosis of colorectal stromal tumor are few at home and abroad. In this study, we performed survival analyses for colorectal stromal tumor. The nomogram made by prognostic factors provided basis for evaluation of prognosis.Methods: The clinico-pathological and prognostic data of colorectal stromal tumor between January 1992 and December 2015 were collected from the surveillance, epidemiology, and end results (SEER) database. The survival analyses were made by SPSS 24.0 software. The nomogram and calibration curve were made by RMS package in R 3.5.2 software.Results: In the study, 546 patients with colorectal stromal tumor were included. The median age of onset was 64 years. The regional lymph node metastasis (LNM) rate was 9.4%. The multivariate Cox regression analyses of the 546 cases showed that the older age of onset (>64 years), single or divorce, colon tumor (compared with rectal tumor), non-surgery, high histological grade, LNM and distant metastasis were associated with worse cancer specific survival (CSS) and overall survival (OS), P < 0.05 for all. The treatment district was independent prognostic factor of OS (P = 0.027). The C-index of independent prognostic factors predicting CSS and OS probability were 0.76 (95%CI: 0.72-0.80) and 0.75 (95%CI: 0.72-0.78), respectively. Multivariate analyses were further carried out in the 174 patients with definite histological grade and tumor location, which revealed that the age of onset, histological grade, surgery or not were independent prognostic factors of CSS and OS (P < 0.05 for all). Tumor location was associated with CSS (P = 0.041) but not OS (P = 0.057) among the 174 cases. Four independent prognostic factors influencing the 174 patients' prognosis were used to make nomogram for predicting survival probability of 546 cases. The C-index of four prognostic factors predicting probability of CSS and OS of the 546 cases were separately 0.71 (95%CI: 0.66-0.75) and 0.73 (95%CI: 0.70-0.77). The nomogram had more accuracy for predicting OS probability of colorectal stromal tumors.Conclusion: The prognosis of colorectal stromal tumor was affected by multiple clinicopathological factors. The nomogram provided the basis for predicting the survival probability of patients with colorectal stromal tumor.

Key words: Colorectal stromal tumor, Clinicopathological features, Prognosis, Nomogram

CLC Number: 

  • R735.3

Table 1

Clinicopathological characteristics and follow-up data of 546 patients with colorectal stromal tumor"

Variables n (%)
Age/years
≤ 64 273 (50)
> 64 273 (50)
Gender
Male 302 (55.3)
Female 244 (44.7)
Marital status
Married 321 (58.8)
Single/divorced 192 (35.2)
Unknown 33 (6.0)
Ethnicity
Caucasian 361 (66.1)
African-American 93 (17.0)
Other 91 (16.7)
Unknown 1 (0.2)
Date range/year
1992-2007 276 (50.5)
2008-2015 270 (49.5)
SEER registry in America
Eastern 238 (43.6)
Western 308 (56.4)
Tumor location
Colon 241 (44.1)
Rectum 280 (51.3)
Unknown 25 (4.6)
Surgery or not
Yes 428 (78.4)
No 109 (20.0)
Unknown 9 (1.6)
Differentiation grade
Ⅰ 35 (6.4)
Ⅱ 56 (10.3)
Ⅲ 34 (6.2)
Ⅳ 54 (9.9)
Unknown 367 (67.2)
Tumor size/cm*
≤ 2 65 (11.9)
> 2-5 89 (16.3)
> 5-10 120 (22.0)
> 10 50 (9.2)
Unknown 222 (40.7)
Lymphadenectomy
No 310 (56.8)
Yes 204 (37.4)
Unknown 32 (5.9)
LNM
Negative 184 (33.7)
Positive 19 (3.5)
Unknown 343 (62.8)
LNM rate 19/203 (9.4)
Distant metastasis
No 292 (53.5)
Yes 47 (8.6)
Unknown 207 (37.9)
Cancer-specific death
Yes 123 (22.5)
No 423 (77.5)
Overall survival status
Dead 239 (43.8)
Alive 307 (56.2)

Table 2

Univariate survival analyses of 546 patients with colorectal stromal tumor"

Variables n CSS P OS P
5-year survival rate/% 10-year survival rate/% 5-year survival rate/% 10-year survival rate/%
Age/years < 0.001 < 0.001
≤ 64 273 85.2 76.8 79.1 66.5
> 64 273 71.4 56.3 49.4 25.0
Gender 0.792 0.934
Male 302 78.7 67.5 64.8 46.1
Female 244 78.8 68.4 63.6 46.0
Marital status 0.027 0.007
Married 321 80.6 70.6 67.8 50.1
Single/Divorced 192 73.8 61.2 56.8 38.5
Unknown 33 88.6 78.8 74.4 45.5
Ethnicity 0.154 0.035
Caucasian 361 75.9 65.9 59.7 44.0
African-American 93 87.1 74.5 73.8 48.6
Other/Unknown 92 80.7 67.7 72.6 49.5
Date range/year 0.146 0.733
1992-2007 276 76.0 66.7 62.5 46.5
2008-2015 270 82.6 70.0 66.1 43.7
SEER registry in America 0.029 0.063
Eastern 238 81.8 76.9 68.7 52.7
Western 308 76.3 62.9 61.0 42.2
Tumor location 0.002 < 0.001
Colon 241 69.1 60.6 53.4 41.0
Rectum 280 86.6 74.2 73.9 53.5
Unknown 25 84.8 68.9 66.2 12.1
Surgery or not < 0.001 < 0.001
No/Unknown 118 61.3 31.7 38.9 20.1
Surgery 428 82.1 73.3 70.6 51.7
Differentiation grade < 0.001 < 0.001
Ⅰ 35 97.1 83.3 93.5 74.8
Ⅱ 56 90.1 84.1 82.9 71.0
Ⅲ 34 55.8 55.8 41.5 26.0
Ⅳ 54 67.8 40.5 48.5 22.2
Unknown 367 79.4 68.5 64.0 47.3
Tumor size/cm* 0.001 < 0.001
≤2 65 95.0 95.0 82.8 77.6
>2-5 89 89.4 61.3 73.8 48.5
>5-10 120 83.3 76.8 69.9 55.7
>10 50 74.9 59.0 61.9 37.5
Unknown 222 69.7 61.6 54.7 38.8
Lymphadenectomy 0.325 0.652
No/Unknown 342 82.2 69.7 65.4 47.5
Yes 204 75.0 66.9 62.4 45.1
LNM < 0.001 < 0.001
Negative/Unknown 527 79.7 70.6 65.2 48.4
Positive 19 41.9 20.9 38.3 6.4
Distant metastasis < 0.001 < 0.001
No/Unknown 499 81.9 71.3 67.5 48.6
Yes 47 32.6 32.6 23.6 23.6

Table 3

Multivariate survival analyses of 546 patients with colorectal stromal tumor"

Variables n CSS P OS P
HR 95%CI HR 95%CI
Age/years
≤ 64 273 1 1
> 64 273 2.53 1.71-3.73 < 0.001 3.82 2.83-5.14 < 0.001
Gender
Male 302 1 1
Female 244 0.81 0.55-1.19 0.284 0.83 0.62-1.09 0.182
Marital status
Married 321 1 1
Single/divorced 192 1.71 1.14-2.57 0.010 1.51 1.12-2.03 0.006
Unknown 33 0.67 0.23-1.92 0.456 0.74 0.38-1.46 0.391
Ethnicity
Caucasian 361 1 1
African-American 93 0.79 0.43-1.45 0.449 0.90 0.60-1.36 0.618
Other/Unknown 92 0.93 0.55-1.58 0.788 0.76 0.51-1.14 0.191
Date range/year
1992-2007 276 1 1
2008-2015 270 0.95 0.56-1.59 0.834 1.22 0.84-1.76 0.295
SEER registry in America
Eastern 238 1 1
Western 308 1.46 0.97-2.20 0.073 1.39 1.04-1.86 0.027
Tumor location
Colon 241 1 1
Rectum 280 0.58 0.38-0.89 0.012 0.67 0.50-0.91 0.010
Unknown 25 0.50 0.20-1.23 0.129 0.70 0.39-1.24 0.219
Surgery or not
No/Unknown 118 1 1
Surgery 428 0.40 0.24-0.70 0.001 0.46 0.32-0.68 < 0.001
Differentiation grade
Ⅰ 35 1 1
Ⅱ 56 2.07 0.40-10.71 0.385 1.74 0.64-4.73 0.274
Ⅲ 34 5.54 1.15-26.59 0.032 4.18 1.58-11.05 0.004
Ⅳ 54 7.75 1.67-35.94 0.009 6.22 2.45-15.82 < 0.001
Unknown 367 3.90 0.88-17.20 0.072 3.09 1.28-7.47 0.012
Tumor size/cm*
≤ 2 65 1 1
> 2-5 89 1.72 0.45-6.54 0.423 1.23 0.57-2.68 0.603
> 5-10 120 2.03 0.58-7.14 0.268 1.49 0.72-3.08 0.286
> 10 50 3.11 0.85-11.30 0.085 1.87 0.86-4.06 0.115
Unknown 222 3.84 1.13-13.06 0.031 2.81 1.39-5.67 0.004
Lymphadenectomy
No/Unknown 342 1 1
Yes 204 1.00 0.63-1.60 0.987 0.90 0.64-1.25 0.519
LNM
Negative/Unknown 527 1 1
Positive 19 2.88 1.41-5.88 0.004 2.50 1.41-4.42 0.002
Distant metastasis
No/Unknown 499 1 1
Yes 47 2.55 1.48-4.40 0.001 1.91 1.24-2.95 0.003

Table 4

Multivariate survival analyses of 174 patients diagnosed as colorectal stromal tumor with histological grade and tumor location"

Variables n CSS P OS P
HR 95%CI HR 95%CI
Age/years
≤ 64 83 1 1
> 64 91 2.27 1.05-4.91 0.037 4.97 2.70-9.15 < 0.001
Gender
Male 89 1 1
Female 85 1.02 0.48-2.18 0.963 1.12 0.64-1.98 0.696
Marital status
Married 107 1 1
Other 67 0.58 0.24-1.38 0.215 0.99 0.55-1.80 0.972
Ethnicity
Caucasian 121 1 1
African-American 28 0.69 0.21-2.35 0.557 0.51 0.20-1.27 0.149
Other/Unknown 25 1.43 0.48-4.21 0.520 0.69 0.27-1.77 0.441
Date range/year
1992-2007 86 1 1
2008-2015 88 0.36 0.10-1.31 0.120 0.76 0.28-2.08 0.589
SEER registry in America
1992-2007 74 1 1
2008-2015 100 0.92 0.42-2.02 0.827 1.08 0.61-1.93 0.795
Tumor location
Colon 91 1 1
Rectum 83 0.43 0.19-0.97 0.041 0.58 0.34-1.02 0.057
Surgery or not
No/Unknown 13 1 1
Surgery 161 0.15 0.04-0.58 0.006 0.29 0.11-0.81 0.018
Differentiation grade
Ⅰ 34 1 1
Ⅱ 54 2.93 0.54-15.96 0.213 2.35 0.77-7.18 0.133
Ⅲ 32 7.93 1.47-42.75 0.016 4.39 1.43-13.47 0.010
Ⅳ 54 8.59 1.73-42.57 0.008 7.02 2.38-20.70 < 0.001
Tumor size/cm*
≤ 2 27 1 1
> 2-5 30 0.46 0.07-2.91 0.412 0.77 0.14-4.34 0.766
> 5-10 33 0.41 0.06-2.93 0.378 1.56 0.28-8.59 0.610
> 10 14 0.72 0.09-5.66 0.754 1.81 0.32-10.32 0.506
Unknown 70 0.29 0.03-2.49 0.258 1.23 0.19-7.88 0.826
Lymphadenectomy
No/Unknown 92 1 1
Yes 82 2.14 0.91-5.04 0.083 1.25 0.66-2.36 0.491
LNM
Negative/Unknown 164 1 1
Positive 10 1.30 0.45-3.72 0.631 1.57 0.64-3.85 0.322
Distant metastasis
No/Unknown 155 1 1
Yes 19 2.19 0.94-5.11 0.070 1.64 0.82-3.25 0.159

Figure 1

Nomogram-predicted probability of cancer-specific survival (A) and overall survival (B) for colorectal stromal tumor"

Figure 2

The calibration curve for predicting cancer-specific survival at 5 (A) and 10 (B) years and overall survival at 5 (C) and 10 (D) years"

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