Department of Pathology, Chinese PLA the 309th Hospital, Beijing 100091, China.
World J Gastroenterol. 2012 Apr 14;18(14):1664-71. doi: 10.3748/wjg.v18.i14.1664.
To develop a prognostic approach for gastrointestinal stromal tumors (GISTs) using a cluster of indicators and follow-up information.
One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location. By immunohistochemistry, the expressions of PTEN, Ki-67, CD44s matrix metalloproteinase (MMP)-9 and TIMP-1 were detected on tissue microarray. Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.
Our data showed small intestinal GIST are more aggressive than gastric GIST. The NIH risk assessment correlated with disease-free survival for either gastric GIST or small intestinal GIST. Immunohistochemical analysis revealed that Ki-67 labeling indexes (LIs) < 5% predicted higher disease-specific survival (DSS) in gastric and small intestinal GIST. CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST. MMP-9 and TIMP-1 had no correlation with survival. Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST (P = 0.009), as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST (P = 0.011). Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.
PTEN LIs ≥ 50%, Ki-67 LIs < 5% and CD44s positivity provides an accurate, favorable prognosis for gastric GIST. PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST. Ki-67 LIs enhances the NIH assessment.
利用一组指标和随访信息，为胃肠道间质瘤（GIST）开发一种预后方法。
收集 104 例未接受靶向治疗的 GIST 患者，按 NIH 风险评估和解剖位置进行分类。通过组织微阵列，检测 PTEN、Ki-67、CD44s 基质金属蛋白酶（MMP）-9 和 TIMP-1 的免疫组化表达。进行单变量和多标记生存分析，然后构建 COX 风险比例模型，以评估 GIST 的一组预测因子。
我们的数据表明，小肠 GIST 比胃 GIST 更具侵袭性。NIH 风险评估与胃 GIST 或小肠 GIST 的无病生存率相关。免疫组化分析显示，Ki-67 标记指数（LI）<5%预测胃和小肠 GIST 的疾病特异性生存率（DSS）更高。CD44s 阳性和 PTEN LI≥50%与胃 GIST 的更高 DSS 相关。MMP-9 和 TIMP-1 与生存无关。多标记分析显示，PTEN LI≥50%与 Ki-67 LI<5%和 CD44s 阳性的表达模式可靠地预测胃 GIST 的良好结果（P=0.009），PTEN LI≥50%与 Ki-67 LI<5%的组合也预测小肠 GIST 的良好结果（P=0.011）。作者还发现，高 NIH 风险等级与胃 GIST 患者的 DSS 和小肠 GIST 患者的无病生存率相关。
PTEN LI≥50%、Ki-67 LI<5%和 CD44s 阳性为胃 GIST 提供了准确、有利的预后。PTEN LI≥50%和 Ki-67 LI<5%对小肠 GIST 也是如此。Ki-67 LI 增强了 NIH 评估。
