Prognostic impact of gastrointestinal bleeding and expression of PTEN and Ki-67 on primary gastrointestinal stromal tumors

World Journal of Surgical Oncology

Liang Zong¹  Hai-Hang Zhu³  Chang-Ren Zhu⁴  Xue-Wen Gu⁴  Lei Shi²  Wei Zhao²  Xin-Xin Liu²  Ping Chen²  Hao Wang² 

[1] Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, No. 98, Nan-Tong West Road, Yangzhou, Jiangsu 225001, P.R. China;Department of Gastroenterology, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province 225001, P.R. China;Department of Pathology, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province 225001, P.R. China

关键词: tissue microarray;    PTEN;    prognosis;    Ki-67 labeling index;    immunohistochemistry;    gastrointestinal stromal tumors;    gastrointestinal bleeding;   

Others  :  819984
DOI  :  10.1186/1477-7819-12-89

 received in 2013-11-22, accepted in 2014-03-30,  发布年份 2014

【 摘 要 】

Background

Prognostic indicators for gastrointestinal stromal tumors (GISTs) are under investigation. The latest risk classification criteria may still have room for improvement. This study aims to investigate prognostic factors for primary GISTs from three aspects, including clinicopathological parameters, immunohistochemical (IHC) expression of PTEN, and Ki-67 labeling index (LI), and attempts to find valuable predictors for the malignancy potential of primary GISTs.

Methods

Tumor samples and clinicopathological data from 84 patients with primary GISTs after R0 resection were obtained. Immunohistochemical analysis was performed based on tissue microarray (TMA) to estimate expression of PTEN and Ki-67 in tumor cells.

Results

The cut-off point of Ki-67 LI was determined as 1%, using a receiver operator characteristic test with a sensitivity of 71.7% and a specificity of 64.5%. Univariate analysis demonstrated the following factors as poor prognostic indicators for relapse-free survival (RFS) against a median follow-up of 40.25 months: gastrointestinal (GI) bleeding (P = 0.009), non-gastric tumor location (P = 0.001), large tumor size (P = 0.022), high mitotic index (P < 0.001), high cellularity (P = 0.012), tumor rupture (P = 0.013), absent or low expression of PTEN (P = 0.036), and Ki-67 LI >1% (P = 0.043). Gastrointestinal bleeding (hazard ratio, 3.85; 95% confidence interval, 1.63 to 9.10; P = 0.002) was a negative independent risk predictor in multivariate analysis, in addition to tumor size (P = 0.023), and mitotic index (P = 0.002). In addition, GI bleeding showed a good ability to predict recurrence potential, when included in our re-modified risk stratification criteria.

Conclusions

This study suggests that GI bleeding is an independent predictor of poor prognosis for RFS in primary GISTs. Expression of PTEN and Ki-67 are correlated with high risk potential and may predict early recurrence in univariate analysis.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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