Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: Analysis of results in 140 surgically resected patients

Yoshiya Fujimoto, Yukihiro Nakanishi, Kimio Yoshimura, Tadakazu Shimoda

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152 Citations (Scopus)

Abstract

Background. Malignant gastrointestinal stromal tumors (GISTs), previously termed leiomyosarcomas or epithelioid leiomyosarcomas, are known to show wide variability in their malignancy. We evaluated the clinicopathological features of a large number of primary malignant gastric GISTs to clarify which features were independent prognostic factors. Methods. Clinicopathologic features (age, sex, tumor location, mode of growth and size, surgical method, ulceration, cell type, nuclear atypia, cellularity, mitotic index, growth pattern, necrosis, hemorrhage, direct tumor invasion, peripheral lymphoid cuffing, expression of α-smooth muscle actin [α-SMA], desmin, caldesmon, vimentin, CD34, c-kit protein and S-100 protein, and MIB-1 index) were evaluated by multivariate analysis in 140 patients with resected primary malignant gastric GISTs to identify independent prognostic factors. Results. Univariate analysis showed that each of the following factors had a significant deleterious influence on prognosis: male sex, tumor size 10 cm or more, presence of ulceration, an epithelioid cell component, severe nuclear atypia, high cellularity, a mitotic index of more than 10, an exogastric or invasive growth pattern, necrosis, hemorrhage, direct tumor invasion of surrounding tissue, negative caldesmon immunoreactivity, positive S-100 protein immunoreactivity, and a MIB-1 antigen labeling index of more than 10%. Multivariate analysis showed that male sex, tumor size 10 cm or more, presence of an epithelioid cell component, and a mitotic index of more than 10 were statistically significant indicators of a poor prognosis (P = 0.013, 0.001, 0.014, and <0.001, respectively). Multivariate analysis using the MIB-1 index instead of a mitotic count showed that male sex, tumor size 10 cm or more, presence of necrosis, and a MIB-1 antigen labeling index of more than 10% were independent predictors of a poor prognosis (P = 0.009, 0.001, 0.043, and <0.001, respectively). Conclusion. Male sex, tumor size 10 cm or more, and cell proliferation as estimated by the mitotic index or MIB-1 index are independent indicators of a poor prognosis in primary malignant gastric GIST.

Original languageEnglish
Pages (from-to)39-48
Number of pages10
JournalGastric Cancer
Volume6
Issue number1
DOIs
Publication statusPublished - 2003
Externally publishedYes

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Gastrointestinal Stromal Tumors
Statistical Factor Analysis
Stomach
Mitotic Index
Neoplasms
Ki-67 Antigen
Calmodulin-Binding Proteins
Epithelioid Cells
Necrosis
Multivariate Analysis
Leiomyosarcoma
S100 Proteins
Cellular Structures
Growth
Proto-Oncogene Proteins c-kit
Hemorrhage
Desmin
Protein S
Vimentin
Smooth Muscle

Keywords

  • Clinicopathologic study
  • Malignant gastric GIST
  • Multivariate analysis Immunohistochemistry
  • Prognostic factor

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

@article{cf41daa9a4c544008ade24d8e9bc1811,
title = "Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors: Analysis of results in 140 surgically resected patients",
abstract = "Background. Malignant gastrointestinal stromal tumors (GISTs), previously termed leiomyosarcomas or epithelioid leiomyosarcomas, are known to show wide variability in their malignancy. We evaluated the clinicopathological features of a large number of primary malignant gastric GISTs to clarify which features were independent prognostic factors. Methods. Clinicopathologic features (age, sex, tumor location, mode of growth and size, surgical method, ulceration, cell type, nuclear atypia, cellularity, mitotic index, growth pattern, necrosis, hemorrhage, direct tumor invasion, peripheral lymphoid cuffing, expression of α-smooth muscle actin [α-SMA], desmin, caldesmon, vimentin, CD34, c-kit protein and S-100 protein, and MIB-1 index) were evaluated by multivariate analysis in 140 patients with resected primary malignant gastric GISTs to identify independent prognostic factors. Results. Univariate analysis showed that each of the following factors had a significant deleterious influence on prognosis: male sex, tumor size 10 cm or more, presence of ulceration, an epithelioid cell component, severe nuclear atypia, high cellularity, a mitotic index of more than 10, an exogastric or invasive growth pattern, necrosis, hemorrhage, direct tumor invasion of surrounding tissue, negative caldesmon immunoreactivity, positive S-100 protein immunoreactivity, and a MIB-1 antigen labeling index of more than 10{\%}. Multivariate analysis showed that male sex, tumor size 10 cm or more, presence of an epithelioid cell component, and a mitotic index of more than 10 were statistically significant indicators of a poor prognosis (P = 0.013, 0.001, 0.014, and <0.001, respectively). Multivariate analysis using the MIB-1 index instead of a mitotic count showed that male sex, tumor size 10 cm or more, presence of necrosis, and a MIB-1 antigen labeling index of more than 10{\%} were independent predictors of a poor prognosis (P = 0.009, 0.001, 0.043, and <0.001, respectively). Conclusion. Male sex, tumor size 10 cm or more, and cell proliferation as estimated by the mitotic index or MIB-1 index are independent indicators of a poor prognosis in primary malignant gastric GIST.",
keywords = "Clinicopathologic study, Malignant gastric GIST, Multivariate analysis Immunohistochemistry, Prognostic factor",
author = "Yoshiya Fujimoto and Yukihiro Nakanishi and Kimio Yoshimura and Tadakazu Shimoda",
year = "2003",
doi = "10.1007/s101200300005",
language = "English",
volume = "6",
pages = "39--48",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",
number = "1",

}

TY - JOUR

T1 - Clinicopathologic study of primary malignant gastrointestinal stromal tumor of the stomach, with special reference to prognostic factors

T2 - Analysis of results in 140 surgically resected patients

AU - Fujimoto, Yoshiya

AU - Nakanishi, Yukihiro

AU - Yoshimura, Kimio

AU - Shimoda, Tadakazu

PY - 2003

Y1 - 2003

N2 - Background. Malignant gastrointestinal stromal tumors (GISTs), previously termed leiomyosarcomas or epithelioid leiomyosarcomas, are known to show wide variability in their malignancy. We evaluated the clinicopathological features of a large number of primary malignant gastric GISTs to clarify which features were independent prognostic factors. Methods. Clinicopathologic features (age, sex, tumor location, mode of growth and size, surgical method, ulceration, cell type, nuclear atypia, cellularity, mitotic index, growth pattern, necrosis, hemorrhage, direct tumor invasion, peripheral lymphoid cuffing, expression of α-smooth muscle actin [α-SMA], desmin, caldesmon, vimentin, CD34, c-kit protein and S-100 protein, and MIB-1 index) were evaluated by multivariate analysis in 140 patients with resected primary malignant gastric GISTs to identify independent prognostic factors. Results. Univariate analysis showed that each of the following factors had a significant deleterious influence on prognosis: male sex, tumor size 10 cm or more, presence of ulceration, an epithelioid cell component, severe nuclear atypia, high cellularity, a mitotic index of more than 10, an exogastric or invasive growth pattern, necrosis, hemorrhage, direct tumor invasion of surrounding tissue, negative caldesmon immunoreactivity, positive S-100 protein immunoreactivity, and a MIB-1 antigen labeling index of more than 10%. Multivariate analysis showed that male sex, tumor size 10 cm or more, presence of an epithelioid cell component, and a mitotic index of more than 10 were statistically significant indicators of a poor prognosis (P = 0.013, 0.001, 0.014, and <0.001, respectively). Multivariate analysis using the MIB-1 index instead of a mitotic count showed that male sex, tumor size 10 cm or more, presence of necrosis, and a MIB-1 antigen labeling index of more than 10% were independent predictors of a poor prognosis (P = 0.009, 0.001, 0.043, and <0.001, respectively). Conclusion. Male sex, tumor size 10 cm or more, and cell proliferation as estimated by the mitotic index or MIB-1 index are independent indicators of a poor prognosis in primary malignant gastric GIST.

AB - Background. Malignant gastrointestinal stromal tumors (GISTs), previously termed leiomyosarcomas or epithelioid leiomyosarcomas, are known to show wide variability in their malignancy. We evaluated the clinicopathological features of a large number of primary malignant gastric GISTs to clarify which features were independent prognostic factors. Methods. Clinicopathologic features (age, sex, tumor location, mode of growth and size, surgical method, ulceration, cell type, nuclear atypia, cellularity, mitotic index, growth pattern, necrosis, hemorrhage, direct tumor invasion, peripheral lymphoid cuffing, expression of α-smooth muscle actin [α-SMA], desmin, caldesmon, vimentin, CD34, c-kit protein and S-100 protein, and MIB-1 index) were evaluated by multivariate analysis in 140 patients with resected primary malignant gastric GISTs to identify independent prognostic factors. Results. Univariate analysis showed that each of the following factors had a significant deleterious influence on prognosis: male sex, tumor size 10 cm or more, presence of ulceration, an epithelioid cell component, severe nuclear atypia, high cellularity, a mitotic index of more than 10, an exogastric or invasive growth pattern, necrosis, hemorrhage, direct tumor invasion of surrounding tissue, negative caldesmon immunoreactivity, positive S-100 protein immunoreactivity, and a MIB-1 antigen labeling index of more than 10%. Multivariate analysis showed that male sex, tumor size 10 cm or more, presence of an epithelioid cell component, and a mitotic index of more than 10 were statistically significant indicators of a poor prognosis (P = 0.013, 0.001, 0.014, and <0.001, respectively). Multivariate analysis using the MIB-1 index instead of a mitotic count showed that male sex, tumor size 10 cm or more, presence of necrosis, and a MIB-1 antigen labeling index of more than 10% were independent predictors of a poor prognosis (P = 0.009, 0.001, 0.043, and <0.001, respectively). Conclusion. Male sex, tumor size 10 cm or more, and cell proliferation as estimated by the mitotic index or MIB-1 index are independent indicators of a poor prognosis in primary malignant gastric GIST.

KW - Clinicopathologic study

KW - Malignant gastric GIST

KW - Multivariate analysis Immunohistochemistry

KW - Prognostic factor

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U2 - 10.1007/s101200300005

DO - 10.1007/s101200300005

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JF - Gastric Cancer

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