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

World Journal of Surgical Oncology

Research

Hai-Hang Zhu¹  Xin-Xin Liu²  Wei Zhao²  Ping Chen²  Lei Shi²  Hao Wang²  Liang Zong³  Xue-Wen Gu⁴  Chang-Ren Zhu⁴ 

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

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

DOI  :  10.1186/1477-7819-12-89

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

来源: Springer

【 摘 要 】

BackgroundPrognostic 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.MethodsTumor 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.ResultsThe 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.ConclusionsThis 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】

Unknown   
© Wang et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.