An observational study in Duodenal and Gastrointestinal Stromal Tumors, sponsored by First Affiliated Hospital of Fujian Medical University. Active, not recruiting at 2 sites in China. Per ClinicalTrials.gov, last updated 2026-09-23.
Sponsored by First Affiliated Hospital of Fujian Medical University · Observational
Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm of the digestive tract, originating from the interstitial cells of Cajal. GIST can arise anywhere along the gastrointestinal tract, but most commonly occurs in the stomach (50%-60%) and small intestine (20%-30%), with the colorectal region accounting for approximately 10%. Duodenal GIST is a relatively rare subtype, comprising approximately 5% of all GISTs. Due to its low incidence, clinical understanding of duodenal GIST has long been limited, and its clinical presentation is non-specific, varying considerably with tumour size, location, and growth pattern. The most common symptoms are related to gastrointestinal bleeding, including melaena, haematemesis, haematochezia, or symptomatic anaemia; abdominal pain is also a frequent presentation. With regard to anatomical distribution, the second portion of the duodenum (descending part) is the most commonly involved site.
Surgery is the first-line treatment for localised GIST, and R0 resection (negative margins) is the key to a favourable prognosis. However, because the duodenum is in close proximity to the pancreas, biliary tract, and major vascular structures, surgical decision-making for GIST at this site is far more complex than at other locations. Surgeons must carefully balance oncological radicality against preservation of pancreaticoduodenal function. Despite advances in surgical technique, the risk of recurrence after surgery for duodenal GIST remains substantial. Studies have shown that compared with GIST at other sites, duodenal GIST has a significantly poorer prognosis, and even among patients with the same NIH risk classification, clinical outcomes differ. This suggests that duodenal GIST may exhibit distinct biological behaviour and should not be equated with GIST at other sites. Accurate risk stratification is therefore critical for determining individualised follow-up intervals, the intensity of adjuvant therapy, and informed patient decision-making.
The most widely used risk stratification tool for GIST is the modified National Institutes of Health (NIH) classification, which is based on tumour size, mitotic count, and primary site. However, this classification was developed primarily from data on gastric GIST, and its performance in non-gastric GIST remains highly controversial. Previous studies have reported a C-statistic of 0.73 for the modified NIH criteria in gastric GIST, but only 0.62 in non-gastric GIST; the TNM staging system has demonstrated superior prognostic discrimination compared with the modified NIH criteria in intestinal GIST. Given the substantial differences in surgical complexity, recurrence risk, and treatment decision-making between duodenal GIST and GIST at other sites, the application of generic risk stratification tools to this anatomical subgroup is clearly inadequate.
In addition to conventional prognostic factors such as tumour size, mitotic count, and primary site, the prognosis of duodenal GIST may also be influenced by molecular biomarkers and dynamic clinical factors such as perioperative complications. At the genomic level, KIT exon 9 mutations occur at a slightly higher frequency in duodenal GIST than in GIST overall, and have been confirmed as an independent risk factor for overall survival in patients with duodenal GIST. Compared with KIT exon 11 mutations, exon 9 mutations are associated with poorer response to imatinib targeted therapy and a higher risk of metastasis. This molecular difference may partly explain the poorer clinical prognosis observed in duodenal GIST.
Given the limitations of existing risk stratification tools for duodenal GIST, together with the unique clinicopathological features, surgical complexity, and molecular biological background of tumours at this site, the development of a prognostic assessment tool specifically for duodenal GIST is of considerable clinical importance. In recent years, nomogram models have been widely applied to individualised prognostic prediction in various tumours and have demonstrated good predictive performance in the field of GIST. However, an externally validated prediction model specifically for disease-free survival after radical resection of duodenal GIST is currently lacking.
This study, based on multicentre data, aims to develop and externally validate a generalisable nomogram model for predicting disease-free survival (DFS) after radical resection of duodenal GIST, thereby providing a quantitative reference for individualised follow-up and treatment decision-making in clinical practice.
Abstract Introduction: This retrospective study aimed to develop and validate a prognostic model for disease-free survival (DFS) after curative resection of duodenal gastrointestinal stromal Tumours (GIST) to guide individualized surveillance and adjuvant therapy.
Methods: This study included 204 patients with primary duodenal GIST who underwent curative resection at Zhongshan Hospital, Fudan University (January 2010-January 2015; training cohort) and 84 patients from the First Affiliated Hospital of Fujian Medical University (January 2015-January 2023; external validation cohort). Clinical and pathological data were collected. Cox regression identified independent prognostic factors and a nomogram was constructed. Internal validation used bootstrap resampling; discrimination (C-index, time-dependent AUC) and calibration were assessed externally.
This study included patients with primary duodenal gastrointestinal stromal tumour (GIST) who underwent radical surgical resection at two tertiary referral centres in China. The training cohort comprised 204 patients treated at Zhongshan Hospital, Fudan University between January 2010 and January 2015. The external validation cohort comprised 84 patients treated at the First Affiliated Hospital of Fujian Medical University between January 2015 and January 2026. Eligible patients had histopathologically confirmed primary duodenal GIST, underwent radical resection, and had complete clinicopathological and follow-up data. Patients with concurrent or previous other malignancies, metastatic disease or multiple lesions at initial diagnosis, or those who received preoperative systemic therapy were excluded. This study population represents a real-world cohort of duodenal GIST patients treated with curative-intent surgery in routine clinical practice.
Exclusion Criteria:
Patients with primary duodenal gastrointestinal stromal tumour (GIST) who underwent radical resection at Zhongshan Hospital, Fudan University between January 2010 and January 2015. This cohort was used to identify independent prognostic factors and to develop the nomogram prediction model for disease-free survival (DFS).
Patients with primary duodenal gastrointestinal stromal tumour (GIST) who underwent radical resection at the First Affiliated Hospital of Fujian Medical University between January 2015 and January 2026. This independent cohort was used for external validation of the nomogram, including assessment of discrimination (C-index and time-dependent AUC) and calibration.
Disease-free survival (DFS)
Disease-free survival (DFS) was defined as the time from radical resection to tumour recurrence, metastasis, or death from any cause, whichever occurred first. Patients who were alive without recurrence at the last follow-up were censored. DFS was estimated using the Kaplan-Meier method, and the predictive performance of the nomogram was evaluated by discrimination (C-index and time-dependent AUC) and calibration in both the training and external validation cohorts.
Time frame: From the date of radical resection to the date of recurrence, metastasis, or death from any cause, whichever occurred first, assessed up to 10 years after surgery.
Independent prognostic factors for disease-free survival
Clinicopathological variables including tumour size, mitotic count, primary site, KIT exon mutation status, NIH risk classification, surgical margin status, and perioperative complications were analysed using univariate and multivariate Cox proportional hazards regression to identify independent prognostic factors for DFS.
Time frame: Up to 10 years from the date of surgery (baseline).
Discrimination of the nomogram model by concordance index (C-index)
The discriminative ability of the nomogram was assessed using the concordance index (C-index) in both the training cohort and the external validation cohort.
Time frame: From the date of surgery through the last follow-up, assessed up to 10 years.
Calibration of the nomogram model
Calibration of the nomogram was evaluated by comparing predicted versus observed DFS probabilities using calibration curves. A bootstrap resampling method was used for internal validation.
Time frame: Assessed at 5 years after surgery.
Discrimination of the nomogram model by time-dependent AUC at 5 years
The discriminative ability of the nomogram was assessed using the time-dependent area under the receiver operating characteristic curve (AUC) at 5 years after surgery in both the training cohort and the external validation cohort.
Time frame: At 5 years after surgery.
Plan to share: Yes — ndividual participant data (IPD) that underlie the results reported in this article, after de-identification, will be made available upon reasonable request to the corresponding author. Requests should include a detailed research proposal and statistical analysis plan. Data sharing will be subject to approval by the corresponding author and the institutional ethics committee, and a data sharing agreement must be signed before data release.
Supporting information: Study protocol, Sap, Analytic code
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Gastrointestinal Stromal Tumors→
First Affiliated Hospital of Fujian Medical University