Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors

Abstract

AIM:To investigate the incidence of CD117-positive immunohistochemical staining in previously diagnosed GI tract stromal tumors (GIST) and to analyze the tumors' clinical manifestations and prognostic factors. METHODS:We retrospectively reviewed 91 cases with a previous diagnosis of GI stromal tumor, leiomyoma, or leiomyosarcoma. Tissue samples were assessed with CD117, CD34, SMA and S100 immunohistochemical staining. Clinical and pathological characteristics were analyzed for prognostic factors.RESULTS: CD117 was positive in 81 (89 %) of 91 tissue samples. There were 59 cases (72.8 %) positive for CD34, 13 (16 %) positive for SMA, and 12 (14.8 %) positive for S100. There was no gender difference in patients with CD117-positive GIST. Their mean age was 65 years. There were 44 (54 %) tumors located in the stomach and 29 (36 %) in the small intestine. The most frequent presenting symptoms were abdominal pain and GI bleeding. The mean tumor size was 7.5±5.7 cm. There were 35 cases (43.2 %) with tumors >5 cm. The tumor size correlated significantly with tumor mitotic count and resectability. Tumor size, mitotic count, and resectability correlated significantly with tumor recurrence and survival. There was recurrent disease in 39 % of our patients, and their mean survival after recurrence was 16.6 months. Most recurrences were at the primary site or metastatic to the liver. Twenty-six percent of our patients died of their disease. CONCLUSION:Traditional histologic criteria are not specific enough to diagnose GIST. This diagnosis must be confirmed with CD117 immunohistochemical staining. Prognosis is dependent on tumor size, mitotic count, and resectability.Lin SC, Huang MJ, Zeng CY, Wang TI, Liu ZL, Shiay RK. Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors.

Surgical Treatment of Gastrointestinal Stromal Tumors (GISTs)

“…In the multivariate analysis, only the presence of macroscopic residual tumor (R2) was significantly associated (p=0.013) with shorter DSS (Gouveia, Pimenta et al 2008). The DSS and RFS values in our patients fit with results published in other studies (DeMatteo, Lewis et al 2000;Crosby, Catton et al 2001;Fujimoto, Nakanishi et al 2003;Langer, Gunawan et al 2003;Lin, Huang et al 2003;Wong, Young et al 2003;Bucher, Taylor et al 2004;Bucher, Egger et al 2006;Bumming, Ahlman et al 2006). The recurrence rate was significantly lower in R0 cases, but in multivariate analysis only R2 resection was significantly associated with shorter survival of patients.…”

“…Additionally, this series included a substantial number of large dimension GISTs with high biological risk, in which complete macroscopic resection may not prevent the occurrence of recurrence (e.g., metastases) of the tumor or the shorter survival of these patients. In fact, the analysis of the results reported by DeMatteo et al confirms that most resections were performed in patients with large GISTs with high biological risk (Lin, Huang et al 2003;Bucher, Egger et al 2006). The value of negative surgical margin, for instance in GISTs > 10 cm, is highly controversial, since it is possible to argue that those tumors may release to the peritoneal cavity cells not detectable clinically (DeMatteo, Lewis et al 2000;Crosby, Catton et al 2001).…”

“…In addition, some of these reported results may be biased by the effect of adjuvant treatment performed in advanced or incompletely removed GISTs (He, Wang et al 1988;DeMatteo, Lewis et al 2000). Other authors suggest that R0 resections may influence the prognosis of patients (Lehnert 1998;Pidhorecky, Cheney et al 2000;Langer, Gunawan et al 2003;Lin, Huang et al 2003;Wu, Langerman et al 2003;Yan, Marchettini et al 2003;Bucher, Egger et al 2006;Bumming, Ahlman et al 2006;Hinz, Pauser et al 2006;Ahmed, Welch et al 2008); however, these results can also be influenced by the number of incomplete resections in GISTs of high biological risk (Lin, Huang et al 2003). Similar to the reports of DeMatteo et al e Pierie et al (Pierie, Choudry et al 2001), our own results reinforce that complete macroscopic resection of GISTs has a positive impact in the prognosis, being significantly shorter the specific survival of patients with R2 tumor margin status.…”

The Cyclin-Dependent Kinase Inhibitor, p27kip1, Has No Correlation with the Malignant Potential of GIST

“…However, histologic criteria may not be specific enough, and confirmation of the diagnosis obligates the expression of the type III receptor tyrosine kinase, Kit protein (CD 117 antigen) [5, 6]. Other immunohistochemical markers such as CD34, smooth muscle actin, S100 and vimentin may also help in the differentiation of GISTs [7]. …”

Gastrointestinal stromal tumors: A multicenter study of 1160 Turkish cases

“…There is a well-established relationship between these parameters and tumor behavior based on several large clinicopathologic studies (20). In these studies, the number of high-grade or malignant cases are more than other groups (21,26,27). There were 6.1% very low, 21.7% low, 19.3% intermediate, and 53% high-risk cases in our study.…”