GastroClinicopathologic Characteristics of Gastrointestinal Stromal Tumors and Prognostic Importance of Ki-67 Labeling Index: May be a New Prognostic Marker

Year 2022, Volume: 14 Issue: 2, 323 - 328, 29.06.2022

Sıddıka Fındık Gül Kanyılmaz

https://doi.org/10.18521/ktd.1021049

Abstract

Objective: The biological behavior of gastrointestinal stromal tumors (GISTs) varies widely and it is diffucult to predict their malignant potential with the current risk classification criterias. Therefore, we aimed to analyse the prognostic importance of Ki-67 LI for estimating survival outcomes in patients with GISTs.
Methods: For the last 11 years, between 2006 and 2017, who had been treated after surgery were included. A single pathologist re-defined the histologic examples of all cases retrospectively.
Results: Totally, 104 patients were included in the study. The median follow-up time was 73 months (range; 6 to 148 months). Seven of the 104 patients (7%) had local recurrence, 26 of the 104 patients (25%) had distant metastases and 11 of the 104 patients (11%) died during the follow-up period. The mean OS was 133 (range; 124 to 141) and the mean DFS was 117 (range; 107 to 127) months for patients. The disease progression or recurrence during follow up and increasing age were the significant prognostic factors for OS. Mitotic count, growth pattern, tumor location and Ki-67 LI were the significant prognostic factors for DFS. According to multivariate analyses, the Ki-67 LI was the only prognostic factor for estimating disease progression or recurrence (p=0.04).
Conclusion: The most important prognostic factors that affect OS were the age and disease progression or recurrence of disease. Ki-67 LI was the only prognostic factor for estimating disease progression or recurrence. As the follow-up period increases, we think that Ki-67 LI also will affect overall survival.

Keywords

Gastrointestinal Stromal Tumors, Ki-67, Prognostic factors, Survival.

Gastrointestinal Stromal Tümörlerin Klinikopatolojik Özellikleri ve Ki-67 proliferasyon İndeksinin Prognostik Önemi: Yeni Bir Prognostik Belirteç Olabilir

Abstract

Amaç: Gastrointestinal stromal tümörler (GIST'ler), gastrointestinal sistemin en sık görülen mezenkimal neoplazmlarıdır. GIST' lerin biyolojik davranışı çok değişkendir ve mevcut risk sınıflandırma kriterleri ile malignite potansiyellerini tahmin etmek oldukça güçtür. Bu nedenle, çalışmamızda GIST' li hastalarda sağ kalım sonuçlarını tahmin etmek için Ki-67’nin prognostik önemini analiz etmeyi amaçladık.
Yöntem: 2006 ve 2017 yılları arasında cerrahi sonrası tedavi altına alınan hastalar çalışmaya dahil edildi., Tüm vakaların histolojik örneklerini geriye dönük olarak tek patolog tarafından yeniden değerlendirildi.
Bulgular: 104 hasta çalışmaya dahil edildi. Ortalama takip süresi 73 aydı (6- 148 ay). Takip süresince 104 hastanın 7' sinde (% 7) lokal nüks, 26' sında (% 25) uzak metastaz mevcut olup 11' i (% 11) ex idi. Tüm hastalar için ortalama genel sağ kalım (OS) 133 (124-140) aydı. Ortalama hastalıksız sağ kalım (DFS) 117 (107-127) aydı. Takip süresince hastalığın progresyonu, rekürrensi ve yaş artışı OS için önemli prognostik faktörlerdi. Mitoz sayısı, büyüme paterni, tümör yerleşimi ve Ki-67 indeksi DFS için önemli prognostik faktörlerdi. Çok değişkenli analizlere göre, Ki-67 hastalığın ilerlemesi veya nüksünü tahmin etmede tek prognostik faktördü (p = 0.04).
Sonuç: OS' yi etkileyen en önemli prognostik faktörler; yaş, hastalık progresyonu veya nüx idi. Ki-67, hastalık progresyonu veya nüksünü tahmin etmede tek prognostik faktördü. Bu sonuçlar ışığında takip süresi uzadıkça Ki-67’nin genel sağ kalımı da etkileyeceğini düşünüyoruz.

Keywords

Gastrointestinal Stromal Tümör, Ki-67, Prognostik faktörler, Survey

References

• 1. Hechtman JF, DeMatteo R, Nafa K, Chi P, Arcila ME, Dogan S. et al. Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST): a clinicopathologic study of 260 patients with molecular analysis and review of the literature. Ann Surg Oncol. 2015;22:2633-39.
• 2. Yang ML, Wang JC, Zou WB, Yao DK. Clinicopathological characteristics and prognostic factors of gastrointestinal stromal tumors in Chinese patients. Oncol Lett. 2018;16:4905-14.
• 3. Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden Cancer. 2005;103(4):821-9.
• 4. ESMO/European Sarcoma Network Working Group. Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow‐up. Ann Oncol. 2012;23(7):49‐55.
• 5. Atif Ali Hashmi, Mahrukh Faraz, Zareeha Nauman, Muhammad Usman Qureshi, Shumaila Kanwal Hashmi, Hira Fatima Waseem, et al. Clinicopathologic features and prognostic grouping of gastrointestinal stromal tumors (GISTs) in Pakistani patients: an institutional perspective. BMC Res Notes. 2018;11(1):457.
• 6. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459‐65.
• 7. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70‐83.
• 8. Kanyilmaz G, Onder H, Aktan M, Koc M, Bora H, Karahacioglu E, et al. Prognostic Importance of Ki-67 Labeling Index in Grade II Glial Tumors. Turk J Oncol. 2018;33(2):48-53.
• 9. Ogino J, Asanuma H, Hatanaka Y, Matsuno Y, Gotoda H, Muraoka S, et al. Validity and reproducibility of Ki-67 assessment in gastrointestinal stromal tumors and leiomyosarcomas. Pathol Int. 2013;63(2):102-7.
• 10. Pyo JS, Kang G and Sohn JH. Ki-67 labeling index can be used as a prognostic marker in gastrointestinal stromal tumor: a systematic review and meta-analysis. Int J Biol Markers. 2016; 31(2):204-10.
• 11. Li J, Zhang H, Chen Z, Su K. Clinicopathological characteristics and prognostic factors of gastrointestinal stromal tumors among a Chinese population. Int J Clin Exp Pathol 2015;8(12):15969-76.
• 12. Kramer K, Knippschild U, Mayer B, Bögelspacher K, Spatz H, Henne-Bruns D, et al. Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST). BMC Cancer 2015;15:57.
• 13. Zhang P, Deng R, Liu K, Shuai XM, Bai J, Chang WL, et al. Clinicopathologic features and prognosis of primary gastrointestinal stromal tumor patients under 35 years of age: A 10 year retrospective study. J Surg Oncol. 2016;114(8):977 81.
• 14. Kim KM, Kang DW, Moon WS, Park JB, Park CK, Sohn JH, et al. Gastrointestinal stromal tumors in Koreans: It’s incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci. 2005;20(6):977-84.
• 15. Koay MH, Goh YW, Iacopetta B, Grieu F, Segal A, Sterrett GF, et al. Gastrointestinal stromal tumours (GISTs): A clinicopathological and molecular study of 66 cases. Pathology. 2005;37(1):22-31.
• 16. Loria N, Sawaya RA, Friedenberg FK. Review article: The biology, diagnosis and management of gastrointestinal stromal tumours. Aliment Pharmacol Ther. 2014;39(12):1376-86.
• 17. Yan H, Marchettini P, Acherman YI, Gething SA, Brun E, Sugarbaker PH. Prognostic assessment of gastrointestinal stromal tumor. Am J Clin Oncol. 2003;26(3):221-8.
• 18. Supsamutchaia C, Wilasrusmeea C, Hiranyatheba P, Jirasirithama J, Rakchoba T, Choikrua P. A cohort study of prognostic factors associated with recurrence or metastasisof gastrointestinal stromal tumor (GIST) of stomach. Annals of Medicine and Surgery. 2018;35,1-5.
• 19. Wen-Yi Zhao, Jia Xu, Ming Wang, Zi-Zhen Zhang, Lin Tu, Chao-Jie Wang, et al. Prognostic value of Ki67 index in gastrointestinal stromal tumors. Int J Clin Exp Pathol. 2014;7(5):2298-2304.
• 20. Xuechao Liu, Haibo Qiu MD, Peng Zhang, Xingyu Feng, Tao Chen, Yong Li, et al; on behalf of China Gastrointestinal Stromal Tumor Study Group. Ki-67 labeling index may be a promising indicator to identify “very high-risk” gastrointestinal stromal tumor: a multicenter retrospective study of 1022 patients. Human Pathology. 2018;74,17–24.
• 21. Sozutek D, Yanik S, Akkoca AN, Sozutek A, Ozdemir ZT, Avsar C, et al. Diagnostic and prognostic roles of DOG1 and Ki-67, in GIST patients with localized or advanced/metastatic disease. Int J Clin Exp Med 2014;7(7):1914-22.