基于机器学习构建胃肠间质瘤术后复发风险的预测模型

张 瑶, 祁义 军*
安徽医科大学第一附属医院

摘要


目的：探索胃肠间质瘤术后复发的影响因素，构建决策树和随机森林算法模型，预测术后复发风险并评估其预测效能。方法：回顾性收集安徽医科大学第一附属医院2019-2024年308例接受手术治疗的胃肠间质瘤患者的临床资料。采用最小绝对收缩和选择算子（LASSO）回归筛选特征变量，并构建胃肠间质瘤患者术后复发风险的机器学习预测模型。通过比较两种模型的预测性能，评估其在术后复发风险预测中的效果。结果：在308例行手术治疗的胃肠间质瘤患者中，术后复发的患者70例，术后未复发的患者238例。决策树模型的预测准确率为0.834，召回率为0.646，精确率为0.600，F1分数为0.622；随机森林模型的预测准确率为0.896，召回率为0.600，精确率为0.913，F1分数为0.724。综合比较，随机森林模型的预测性能优于决策树模型。结论：随机森林模型在预测胃肠间质瘤术后复发风险方面具有较高准确性，有效识别术后是否辅助应用靶向药物治疗、肿瘤破裂、Ki67、PLR、MLR等危险因素。该模型可指导医生评估胃肠间质瘤患者术后复发风险，并给予患者相应的预防措施，为临床治疗提供科学依据。

关键词


胃肠间质瘤；术后；复发；决策树模型；随机森林算法模型

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参考


[1]Mantese, George. Gastrointestinal stromal tumor: epidemiology, diagnosis, and treatment. Current Opinion in Gastroenterology 35(6):p 555-559, November 2019.

[2]Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer. 2005 Feb 15;103(4):821-9.

[3]顾怡瑾，李安琪，董磊，等.原发、复发及转移胃肠道间质瘤KIT及PDGFRA突变与临床病理特征间的关系[J].诊断学理论与实践，2021，20（03）：257-264.

[4]von Mehren M, Randall RL, Benjamin RS, et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16(5):536-563.

[5]刘丹丹，李朝辉，刘帅峰.胃肠间质瘤患者术后复发的相关危险因素分析[J].保健医学研究与实践，2023，20（02）：43-46.

[6]范立侨，张新，檀碧波等.胃肠间质瘤术后复发转移的危险因素及预后分析[J].肿瘤学杂志，2021，27（6）：445-449.

[7]Hirota S, Isozaki K, Moriyama Y, et al. Gain ‐ of ‐ function mutations of c ‐ kit in human gastrointestinal stromal tumors[J]. Science, 1998, 279(5350): 577 ‐ 580.

[8]Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors[J]. Science, 2003, 299(5607): 708 ‐ 710.

[9]Gronchi A, Colombo C, Raut CP. Surgical management of localized soft tissue tumors. Cancer. 2014;120(17):2638-2648.

[10]Gronchi A, Raut CP. Treatment of localized sarcomas. Hematol Oncol Clin North Am. 2013;27(5):921-938.

[11]Romandini D, Sobczuk P, Cicala CM, Serrano C. Next questions on gastrointestinal stromal tumors: unresolved challenges and future directions. Curr Opin Oncol. 2025;37(4):358-364.

[12]Tjhoi WEH, Li K, Shou CH, Yang WL, Yu JR. Long-term adjuvant imatinib treatment for a patient who underwent complete resection of a localized recurrent gastrointestinal stromal tumor after preoperative imatinib treatment: A case report. Medicine (Baltimore). 2019;98(6):e14477.

[13]Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol. 2002;33(5):459-465.

[14]Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70-83.

[15]Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39(10):1411-1419.

[16]周岩冰.胃肠间质瘤破裂定义相关问题[J].中华胃肠外科杂志，2021，24（9）：762-768

[17]李旭华，陈玉兰，赖芳.Ki-67标记指数与原发可切除胃肠间质瘤临床病理特征和预后的关系[J].医学理论与实践，2023，36（15）：2625-2627.

[18]石敬勇，李彬，周杨，等.胃肠间质瘤中Ki-67表达对患者预后的作用[J].中华实用诊断与治疗杂志，2021，35（06）：569-571.

[19]Liu X, Qiu H, Wu Z, et al. A Novel Pathological Prognostic Score (PPS) to Identify "Very High-Risk" Patients: a Multicenter Retrospective Analysis of 506 Patients with High Risk Gastrointestinal Stromal Tumor (GIST). J Gastrointest Surg. 2018;22(12):2150-2157.

[20]Liu X, Qiu H, Zhang P, et al. Ki-67 labeling index may be a promising indicator to identify "very high-risk" gastrointestinal stromal tumor: a multicenter retrospective study of 1022 patients. Hum Pathol. 2018;74:17-24.

[21]Li J, Wang AR, Chen XD, Pan H, Li SQ. Ki67 for evaluating the prognosis of gastrointestinal stromal tumors: A systematic review and meta-analysis. Oncol Lett. 2022;23(6):189.

[22]Perez DR, Baser RE, Cavnar MJ, et al. Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor. Ann Surg Oncol. 2013;20(2):593-599.

[23]Stotz M, Liegl-Atzwanger B, Posch F, et al. Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection. PLoS One. 2016;11(7):e0159448. Published 2016 Jul 25.

[24]Lu Z, Li R, Cao X, et al. Assessment of Systemic Inflammation and Nutritional Indicators in Predicting Recurrence-Free Survival After Surgical Resection of Gastrointestinal Stromal Tumors. Front Oncol. 2021;11:710191. Published 2021 Jul 26.


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