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Current trends in the epidemiological and pathological characteristics of gastrointestinal stromal tumors in Korea, 2003-2004.

Cho MY, Sohn JH, Kim JM, Kim KM, Park YS, Kim WH, Jung JS, Jung ES, Jin SY, Kang DY, Park JB, Park HS, Choi YD, Sung SH, Kim YB, Kim H, Bae YK, Kang M, Chang HJ, Chae YS, Lee HE, Park do Y, Lee YS, Kang YK, Kim HK, Chang HK, Hong SW, Choi YH, Shin O, Gu M, Kim YW, Kim GI, Chang SJ - J. Korean Med. Sci. (2010)

Bottom Line: In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival.However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis.The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Wonju College of Medicine Yonsei University, Wonju, Korea.

ABSTRACT
Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

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Univariate analysis of variables of microscopic findings: Tumor necrosis (A), vessel invasion (B), mucosal invasion (C) and histologic type (D) are significantly correlated with patient's survival (P=0.000, 0.000, 0.000, 0.016, respectively).
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Figure 2: Univariate analysis of variables of microscopic findings: Tumor necrosis (A), vessel invasion (B), mucosal invasion (C) and histologic type (D) are significantly correlated with patient's survival (P=0.000, 0.000, 0.000, 0.016, respectively).

Mentions: All the variables except for smooth muscle actin immunoexpression that was significantly correlated with the survival were analyzed in this study with univariate analysis (Figs. 1-4). In ages older than 60 yr, male gender, small intestinal and extra-gastrointestinal location, larger than 10 cm in size, and mitosis more than 5/50 HPF pointed to poor survival rate. All histopathological variables analyzed in the study: mucosal and vessel invasions and necrosis were significantly related with the survival (Fig. 2, P=0.000, P=0.000, and P=0.000, respectively). Spindle cell type tumors showed a better prognosis than mixed, epithelioid, and pleomorphic cell types (Fig. 2, P=0.016). In the classification of GISTs by the NIH criteria, there was no prognostically significant difference between very low and low risk versus intermediate risk tumors, but high-risk tumors pointed significantly to a shorter survival time (Fig. 4, P=0.000). According to the AFIP criteria, the median survival time of malignant tumors was significantly shorter than those of benign and uncertain malignancy (Fig. 4, P=0.000).


Current trends in the epidemiological and pathological characteristics of gastrointestinal stromal tumors in Korea, 2003-2004.

Cho MY, Sohn JH, Kim JM, Kim KM, Park YS, Kim WH, Jung JS, Jung ES, Jin SY, Kang DY, Park JB, Park HS, Choi YD, Sung SH, Kim YB, Kim H, Bae YK, Kang M, Chang HJ, Chae YS, Lee HE, Park do Y, Lee YS, Kang YK, Kim HK, Chang HK, Hong SW, Choi YH, Shin O, Gu M, Kim YW, Kim GI, Chang SJ - J. Korean Med. Sci. (2010)

Univariate analysis of variables of microscopic findings: Tumor necrosis (A), vessel invasion (B), mucosal invasion (C) and histologic type (D) are significantly correlated with patient's survival (P=0.000, 0.000, 0.000, 0.016, respectively).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2877229&req=5

Figure 2: Univariate analysis of variables of microscopic findings: Tumor necrosis (A), vessel invasion (B), mucosal invasion (C) and histologic type (D) are significantly correlated with patient's survival (P=0.000, 0.000, 0.000, 0.016, respectively).
Mentions: All the variables except for smooth muscle actin immunoexpression that was significantly correlated with the survival were analyzed in this study with univariate analysis (Figs. 1-4). In ages older than 60 yr, male gender, small intestinal and extra-gastrointestinal location, larger than 10 cm in size, and mitosis more than 5/50 HPF pointed to poor survival rate. All histopathological variables analyzed in the study: mucosal and vessel invasions and necrosis were significantly related with the survival (Fig. 2, P=0.000, P=0.000, and P=0.000, respectively). Spindle cell type tumors showed a better prognosis than mixed, epithelioid, and pleomorphic cell types (Fig. 2, P=0.016). In the classification of GISTs by the NIH criteria, there was no prognostically significant difference between very low and low risk versus intermediate risk tumors, but high-risk tumors pointed significantly to a shorter survival time (Fig. 4, P=0.000). According to the AFIP criteria, the median survival time of malignant tumors was significantly shorter than those of benign and uncertain malignancy (Fig. 4, P=0.000).

Bottom Line: In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival.However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis.The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Wonju College of Medicine Yonsei University, Wonju, Korea.

ABSTRACT
Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

Show MeSH
Related in: MedlinePlus