OBJECTIVETo identify prognostic factors in patients with gastrointestinal stromal tumors (GIST).

METHODSHematoxylin and eosin (H&E) stained histopathological slides of tumors from patients with mesenchymal neoplasms growing in the gastrointestinal tract and abdomen were reviewed. Two histologically representative areas were identified and chosen for tissue microarray. Immunohistochemical staining was performed to demonstrate c-kit protein (CD117), CD34, smooth muscle actin, desmin and S-100 protein. The relations of various clinicopathologic features to outcome were analyzed.

RESULTSThe overall disease-specific survival of 194 patients was 93.5% at 1 year, 72.1% at 3 years and 63.2% at 5 years. Univariate analysis indicated that the tumor size, mitotic count, primary location, necrosis, high cellularity, mucosal invasion, mixed cell type, hemorrhage, direct tumor invasion of surrounding tissue, male sex, incompleteness of resection, cytologic atypia were significant predictors of survival. Multivariate analysis showed that tumor size, mitotic count, necrosis, direct tumor invasion of surrounding tissue and male sex were poor prognostic signs.

CONCLUSIONTumor size and mitotic count are important prognostic factors. However, to evaluate the prognosis of these tumors, a surgical pathologist should incorporate multiple parameters into their histologic evaluation in attempt to reach an appropriate opinion on the aggressiveness of GIST.

Aged ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; diagnosis ; mortality ; pathology ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Survival Rate

BACKGROUND/AIMS: Assessment of malignant potential in gastrointestinal stromal tumor (GIST) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth. The aim of this study was to investigate the prognostic value of Ki-67 in GIST. METHODS: We retrospectively reviewed the medical records of 32 patients with GIST who underwent surgical resection at Inje University Seoul Paik Hospital. We analyzed their Ki-67 expression, histologic finding, and prognosis. RESULTS: According to the tumor size and mitotic count, 4 patients were classified as very low risk, 9 patients as low risk, 14 patients as intermediate risk and 5 patients as high risk. The average Ki-67 index was 5.56+/-4.48%. The median follow-up duration was 35.72+/-29.04 months, and local/distant recurrences were observed in 6 (18.7%) patients. The overall cumulative disease free survival rates in patients with Ki-67 index < or =5% at 1 year, 2 years, and 5 years were 100%, 100%, and 86%, respectively. The overall cumulative disease free survival rates in patients with Ki-67 index >5% were at 1 year, 2 years, and 5 years were 82.1%, 70.3%, and 46.9%, respectively. There was significant relationship between elevated Ki-67 and disease free survival rate (p=0.007). CONCLUSIONS: Our study suggests that Ki-67 index >5% confers a higher risk of relapse in patients with GIST. Future work should focus on standardization of Ki-67 assessment and specification of its role in making treatment decisions.
Adult ; Aged ; Disease-Free Survival ; Female ; Gastrointestinal Neoplasms/*diagnosis/mortality/pathology ; Gastrointestinal Stromal Tumors/*diagnosis/mortality/pathology ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Ki-67 Antigen/*metabolism ; Linear Models ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies

BACKGROUND: Small bowel tumors are relatively uncommon, accounting for only 3 to 6% of all gastrointestinal tumors. Their infrequency and the lack of specific symptoms can result in delayed diagnosis and poor prognosis. The purpose of this study was to find a relationship between the pathology and the clinical features of primary tumors of the jejunum and the ileum. METHODS: We analyzed the clinicopathological findings of 28 patients with primary tumors of the jejunum and the ileum who had undergone surgery at the Department of Surgery, Asan Medical Center, between June 1989 and December 1997. RESULTS: Among the 28 patients, there were 20 men and 8 women. The mean age was 54 years (13-76 years). The tumors consisted of 10 malignant gastrointestinal stromal tumors (GISTs), 7 lymphomas, 6 benign GISTs, 3 adenocarcinomas, and 2 lipomas. The clinical symptoms of these patients were abdominal pain (54%), GI bleeding (32%), nausea & vomiting (14%), weight loss (14%), palpation of abdominal mass (11%), and dizziness (11%). The preoperative complications were bleeding (32%), perforation (18%), intussusception (11%), and obstruction (7%). Bleeding was found in GISTs only and was more frequent in benign GISTs(100%) than in malignant GISTs (30%). Perforation was found in malignant tumors only (25%). Among the 20 patients with malignant tumors, chemotherapy was done in 13, and the 2-year survival rate was 75%. CONCLUSIONS: Early diagnosis of small bowel tumors is essential to prevent complications such as bleeding and perforation and to reduce mortality. Early diagnosis and surgery seem to be indispensable to a good outcome in symptomatic patients.
Abdominal Pain ; Adenocarcinoma ; Chungcheongnam-do ; Delayed Diagnosis ; Dizziness ; Drug Therapy ; Early Diagnosis ; Female ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Ileum* ; Intussusception ; Jejunum* ; Lipoma ; Lymphoma ; Male ; Mortality ; Nausea ; Palpation ; Pathology ; Prognosis ; Survival Rate ; Vomiting ; Weight Loss