Abstract
OBJECTIVES: Post-surgical prediction of recurrence or metastasis for primary gastrointestinal stromal tumors (GISTs) remains challenging. We aim to develop individualized clinical follow-up strategies for primary GIST patients, such as shortening follow-up time or extending drug administration based on the clinical deep learning radiomics model (CDLRM). METHODS: The clinical information on primary GISTs was collected from two independent centers. Postoperative recurrence or metastasis in GIST patients was defined as the endpoint of the study. A total of nine machine learning models were established based on the selected features. The performance of the models was assessed by calculating the area under the curve (AUC). The CDLRM with the best predictive performance was constructed. Decision curve analysis (DCA) and calibration curves were analyzed separately. Ultimately, our model was applied to the high-potential malignant group vs the low-malignant-potential group. The optimal clinical application scenarios of the model were further explored by comparing the DCA performance of the two subgroups. RESULTS: A total of 526 patients, 260 men and 266 women, with a mean age of 62 years, were enrolled in the study. CDLRM performed excellently with AUC values of 0.999, 0.963, and 0.995 for the training, external validation, and aggregated sets, respectively. The calibration curve indicated that CDLRM was in good agreement between predicted and observed probabilities in the validation cohort. The results of DCA's performance in different subgroups show that it was more clinically valuable in populations with high malignant potential. CONCLUSION: CDLRM could help the development of personalized treatment and improved follow-up of patients with a high probability of recurrence or metastasis in the future. CRITICAL RELEVANCE STATEMENT: This model utilizes imaging features extracted from CT scans (including radiomic features and deep features) and clinical data to accurately predict postoperative recurrence and metastasis in patients with primary GISTs, which has a certain auxiliary role in clinical decision-making. KEY POINTS: We developed and validated a model to predict recurrence or metastasis in patients taking oral imatinib after GIST. We demonstrate that CT image features were associated with recurrence or metastases. The model had good predictive performance and clinical benefit.