Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors.
OBJECTIVE
To investigate the incidence of CD117-positive immunohistochemical staining in previously diagnosed gastrointestinal (GI) tract stromal tumors (GIST) and to analyze the tumors' clinical manifestations and prognostic factors.


METHODS
We retrospectively reviewed 91 cases with a previous diagnosis of GI stromal tumor, leiomyoma, or leiomyosarcoma. Tissue samples were assessed with CD117, CD34, SMA and S100 immunohistochemical staining. Clinical and pathological characteristics were analyzed for prognostic factors.


RESULTS
CD117 was positive in 81 (89%) of 91 tissue samples. There were 59 cases (72.8%) positive for CD34, 13 (16%) positive for SMA, and 12 (14.8%) positive for S100. There was no gender difference in patients with CD117-positive GIST. Their mean age was 65 years. There were 44 (54%) tumors located in the stomach and 29 (36%) in the small intestine. The most frequent presenting symptoms were abdominal pain and GI bleeding. The mean tumor size was 7.5 +/- 5.7 cm. There were 35 cases (43.2%) with tumors >5 cm. The tumor size correlated significantly with tumor mitotic count and resectability. Tumor size, mitotic count, and resectability correlated significantly with tumor recurrence and survival. There was recurrent disease in 39% of our patients, and their mean survival after recurrence was 16.6 months. Most recurrences were at the primary site or metastatic to the liver. Twenty-six percent of our patients died of their disease.


CONCLUSIONS
Traditional histologic criteria are not specific enough to diagnose GIST. This diagnosis must be confirmed with CD117 immunohistochemical staining. Prognosis is dependent on tumor size, mitotic count, and resectability.
Lin
Shee-Chan
SC
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China. sheechan@ms2.mmh.org.tw
Huang
Ming-Jer
MJ
Zeng
Chen-Yuan
CY
Wang
Tzang-In
TI
Liu
Zen-Liang
ZL
Shiay
Ray-Kuan
RK
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007889:Leiomyoma / Q000473:pathology; D007890:Leiomyosarcoma / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D012189:Retrospective Studies; D017154:Stromal Cells / Q000473:pathology*; D016019:Survival Analysis; D013997:Time Factors
D015703:Antigens, CD; D019009:Proto-Oncogene Proteins c-kit