title: Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach.
abstract: OBJECTIVE
  Whether immunohistochemical markers increase accuracy in predicting prognosis for gastrointestinal stromal tumours (GISTs) remains uncertain. However, past studies have used only small, heterogeneous patient groups. Our aim was to test previously studied and more novel morphological features as well as four immunohistochemical markers as prognostic indicators amongst a large cohort of surgically resected, gastric GISTs.
  
  
  RESULTS
  Tissues from 127 gastric mesenchymal tumours were collected retrospectively and subjected to repeat histological assessment and immunophenotyping. Further immunohistochemistry was performed for Ki67, p53, Bcl-2 and cyclin D1. Complete follow-up data were collected for 108 patients with immunophenotyped diagnoses of GIST (i.e. c-kit+ tumours). At the census point, 52 patients were alive, 24 had died from their GISTs and the remainder of other causes. Univariate analysis showed the following predicted for shorter disease-specific survival: size > or =50 mm; necrosis, no intratumoral lymphocytes; mitotic count > or =5/50 high power fields; Ki67 labelling index > or =5%; p53 immunopositivity. Of these variables, multivariate analyses showed only mitotic count and, to a lesser extent, Ki67 labelling to be independent prognostic indicators.
  
  
  CONCLUSIONS
  Mitotic count remains the best predictor of outcome following surgical resection of gastric GISTs. Ki67 immunohistochemistry does not provide better prognostication and p53, Bcl-2 and cyclin D1 immunohistochemistry provide no additional prognostication.
authors.affiliation: Department of Pathology, University of Edinburgh Medical School, Edinburgh, UK. newton.wong@cancer.org.uk
authors.forename: N A C S
authors.initials: NA
authors.lastname: Wong
authors.forename: R
authors.initials: R
authors.lastname: Young
authors.forename: R D G
authors.initials: RD
authors.lastname: Malcomson
authors.forename: A G
authors.initials: AG
authors.lastname: Nayar
authors.forename: L A
authors.initials: LA
authors.lastname: Jamieson
authors.forename: V E
authors.initials: VE
authors.lastname: Save
authors.forename: F A
authors.initials: FA
authors.lastname: Carey
authors.forename: D H
authors.initials: DH
authors.lastname: Brewster
authors.forename: C
authors.initials: C
authors.lastname: Han
authors.forename: A
authors.initials: A
authors.lastname: Al-Nafussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002455:Cell Division; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000378:metabolism; D007889:Leiomyoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D017154:Stromal Cells / Q000378:metabolism / Q000473:pathology*; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen