title: [Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction].
abstract: OBJECTIVE
  To analyze the different factors predictive of survival associated with optimal R0-cytoreduction in c-kit-positive gastrointestinal stromal tumors.
  
  
  METHODS
  Thirty-five patients were operated on in our Oncological Surgery Department from January 2002 to February 2007 because of CD117/c-kit-positive gastrointestinal stromal tumors, and an optimal surgical cytoreduction was obtained without macroscopical residual disease. Demographic, anatomical, clinical, pathological, and immunohistochemical variables were analyzed from a specific database. Survival and multivariate analyses were developed using Kaplan-Meier and multiple Cox regression models, respectively.
  
  
  RESULTS
  Five-year overall survival was 77% with a mean survival of 52 months. Risk of malignant behaviour according to Fletcher s classification and tumor size higher than 10 cm had a significantly negative influence on overall survival in the univariate analysis (p < 0.05). Proliferative Ki-67 activity higher than 50% was the only statistically significant variable in the multivariate analysis. Twenty percent of tumors recurred. Only 3 patients with metastatic disease received adjuvant treatment with imatinib mesylate, all of them with Ki-67 > 50% and currently alive.
  
  
  CONCLUSIONS
  The poliferative Ki-67 index could represent an excellent predictive factor for survival in patients with c-kit-positive stromal gastrointestinal tumors. Confirmation and an adequate cut-off level should be the main objectives for future prospective studies, mostly focused on the appropriate selection of optimal candidates to imatinib-mesylate-based treatment.
authors.affiliation: Depatamento de Cirugía, Sericio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Oncológica, Hospital Universitario Reina Sofía, Córdoba. juanmanuelsanchezhidalgo@hotmail.com
authors.forename: J M
authors.initials: JM
authors.lastname: Sánchez Hidalgo
authors.forename: F C
authors.initials: FC
authors.lastname: Muñoz Casares
authors.forename: S
authors.initials: S
authors.lastname: Rufian Peña
authors.forename: A
authors.initials: A
authors.lastname: Naranjo Torres
authors.forename: R
authors.initials: R
authors.lastname: Ciria Bru
authors.forename: J
authors.initials: J
authors.lastname: Briceño Delgado
authors.forename: P
authors.initials: P
authors.lastname: López Cillero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate