Does Immunohistochemistry Provide Additional Prognostic Data in Gastrointestinal Stromal Tumors?

  • Demir, Lutfiye (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Ekinci, Nese (Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Erten, Cigdem (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Kucukzeybek, Yuksel (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Alacacioglu, Ahmet (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Somali, Isil (Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University) ;
  • Can, Alper (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Dirican, Ahmet (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Bayoglu, Vedat (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Akyol, Murat (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Cakalagaoglu, Fulya (Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University) ;
  • Tarhan, Mustafa Oktay (Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University)
  • Published : 2013.08.30


Background: To investigate the predictive and prognostic effects of clinicopathologic and immunohistochemical (IHC) features in patients with gastrointestinal stromal tumours (GISTs). Materials and Methods: Fifty-six patients who were diagnosed with GIST between 2002 and 2012 were retrospectively evaluated. Relationships between clinicopathologic/immunohistochemical factors and prognosis were investigated. Results: Median overall survival (OS) of the whole study group was 74.9 months (42.8-107.1 months), while it was 95.2 months in resectable and 44.7 months in metastatic patients respectively (p=0.007). Epitheliolid tumor morphology was significantly associated with shortened OS as compared to other histologies (p=0.001). SMA(+) tumours were significantly correlated with low (<10/50HPF) mitotic activity (p=0.034). Moreover, SMA(+) patients tended to survive longer and had significantly longer disease-free survival (DFS) times than SMA (-) patients (37.7 months vs 15.9 months; p=0.002). High Ki-67 level (${\geq}30%$) was significantly associated with shorter OS (34 vs 95.2 months; 95%CI; p=0.001). CD34 (-) tumours were significantly associated with low proliferative tumours (Ki-67<%10) (p=0.026). Median PFS (progression-free survival) of the patients who received imatinib was 36 months (27.7-44.2 months). CD34 (-) patients had significantly longer PFS times than that of negative tumours; (50.8 vs 29.8 months; p=0.045). S100 and desmin expression did not play any role in predicting the prognosis of GISTs. Multivariate analysis demonstrated that ${\geq}10/50HPF$ mitotic activity/HPF was the only independent factor for risk of death in GIST patients. Conclusions: Despite the negative prognostic and predictive effect of high Ki-67 and CD34 expression, mitotic activity remains the strongest prognostic factor in GIST patients. SMA positivity seems to affect GIST prognosis positively. However, large-scale, multicenter studies are required to provide supportive data for these findings.


Gastrointestinal stromal tumor;immunohistochemistry;predictive potential;prognosis


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