Gastrointestinal Stromal Tumor (GIST) of the Stomach: Clinicopathologic Analysis and Outcome

Ryu, Je Seock; Lee, Sung Ryul; Choi, Sae Byeol; Park, Sung Soo; Lee, Ju Han; Kim, Seung Joo; Kim, Chong Suk; Chae, Yang Seok; Mok, Young Jae

Abstract

PURPOSE
Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. GISTs are positive for the expression of c-Kit protein at immunohistochemistry, and their clinical presentations vary. This retrospective study was performed to evaluate the clincopathologic characteristics of GISTs and to define the prognostic factors.
MATERIALS AND METHODS
40 patients who underwent a complete resection of a GIST during the period 1996~2003 at the Department of Surgery, Korea University College of Medicine, were studied. We divided them into low- and high-risk groups by using tumor size and mitotic count: 23 cases were low risk, and 17 were high risk. Clinicopathologic features, immunohistochemical findings, and prognoses were compared between the low- and the high-risk groups.
RESULTS
The mean age of the 40 patients was 61.3+/-11.1 years, and the male-to-female ratio was 1:1.1. There was no significant difference in age and sex between the groups. A comparative analysis revealed tumor size, mitotic count, clinical symptoms, preoperative pathologic diagnosis, ulceration, and necrosis to be variables that had statistically significant differences between the high- and the low-risk groups. In the univariate analysis, tumor size, mitotic count, ulceration, necrosis, and abnormal endoscopic ultrasound findings were associated with disease-free survival, but in the multivariate analysis, mitotic activity was the only independent factor associated with disease-free survival. 8 patients had recurrences during the follow-up period, and four of them were treated with STI-571 (imatinib mesylate, Gleevec(R)). The treated patients have survived until now; however, two of non-treated patients died from disease progression.
CONCLUSION
Based on this study, tumor size, ulceration, and necrosis are significant factors affecting survival, and mitotic activity may be a useful prognostic marker. STI-571 may be used in an adjuvant setting because the drug has shown anticancer activity in patients with recurrence or metastasis.