Inflammatory Biomarker Correlations and Prognosis in High-risk Gastrointestinal Stromal Tumor Patients: A Multicenter Retrospective Analysis

Abstract

Abstract Background The intricate prognosis of gastrointestinal stromal tumors (GISTs) has garnered significant attention, yet a gap persists in understanding the influence of inflammatory markers on the prognosis of high-risk GIST patients. This study investigated the relationship between various factors and the prognosis of high-risk GIST patients, with a specific focus on first recurrence-free survival (RFS) and overall survival (OS) as crucial prognostic indicators. Methods A comprehensive collection of clinical data was conducted on 145 high-risk GIST patients meeting specific inclusion and exclusion criteria at 17 medical centers in Ningxia, China, covering the period from January 2013 to December 2019. Single-factor analysis and survival curves were used to analyze the variables, while the Cox regression model evaluated independent prognostic factors. Results Within the cohort, a balanced male-to-female ratio of 1:1.1 was observed. Single-factor analysis revealed compelling associations between RFS and age, preoperative neutrophil-to-lymphocyte ratio (NLR), preoperative platelet-to-lymphocyte ratio (PLR), preoperative systemic immune-inflammatory index (SII), preoperative prognostic nutritional index (PNI), mitotic index, and imatinib (IM) with RFS in high-risk GIST patients. These variables also exhibited statistically significant associations with OS (all with p values < 0.05). Cox regression analysis revealed that age, preoperative NLR, mitotic index, IM, and adjuvant therapy independently impacted RFS. Additionally, the preoperative NLR and mitotic index emerged as independent factors influencing OS, all of which demonstrated statistical significance (p values < 0.05). Age exhibited a negative correlation with RFS, and early regular IM treatment following surgery significantly decreased the recurrence risk. An elevated NLR and higher mitotic indices were strongly linked to poorer RFS and OS. Conclusion The data revealed a significant correlation between age, preoperative NLR, and mitotic index and an unfavorable prognosis in high-risk GIST patients. Notably, the NLR was identified as a potential additional prognostic factor, enhancing the accuracy of predicting treatment efficacy and patient outcomes in high-risk patients with GISTs. Therefore, we advocate for the serious consideration of the NLR as a valuable addition to standard clinical practice for managing high-risk GIST patients.