Expression and prognostic role of molecular markers in 99 KIT-positive gastric stromal tumors in Taiwan Residents

瞄准：为了阐明，象肿瘤那样的三个分子的标记的预示的角色和关系压制，增殖或基因 p53 房间原子抗原(PCNA ) 和在胃的基质肿瘤的 Ki-67。方法：108 的一个总数通过手术 resected 胃的平滑肌肿瘤标本从 1987 年 1 月被收集到 1999 年 12 月。Immunohistochemical 研究与 p53， PCNA，和 Ki-67 的抗体在 108 个 CD117 积极的肿瘤中的 99 个的石蜡节上被执行。三个分子的标记的 Immunoreactivity 被把索引标记记录(李， %) 并且为临床病理和幸存关联被分析。结果：99 个盒子，染色的免疫表明 52 个病人(52.5%) 有 p53，并且 37 个病人(37.3%) 有 Ki-67 免疫反应(定义为李的 】10%) 。所有病人(100%) 有 PCNA 免疫反应从 12% ～ 93% 李，划分了成由高或低中部。统计表明三个标记的李断然相关到对方(P【0.01 ) 并且到显微镜的肿瘤有丝分裂的计数(P【0.001 ) 。由联合，有 】=2 标记的病人(积极或高) 在肿瘤有早肿瘤复发(P【0.001 ) 和相反的结果(P【0.001 ) 。Univariate 分析显示有肿瘤尺寸 】5 厘米(P=0.003 ) 的病人，肿瘤有丝分裂 】5/50 HPF (P【0.001 ) ， p53 免疫反应(P=0.001 ) ， Ki-67 免疫反应(P=0.026 ) ，高级李普克纳(P=0.015 ) 和男性(P=0.036 ) 是为早疾病复发的六个预言者。随后多，变量分析表明有丝分裂的计数，肿瘤尺寸，和 p53 免疫反应是为免费的疾病和外套的三个独立预示的因素病人的幸存。由为组织的三个独立预示的因素的联合，我们发现更高的肿瘤再发率(P【0.001 ) 和更短的幸存(P【0.001 ) 与增加因素在组存在。结论：我们首先在大意提供三个分子的标记的预示的价值和连接。三个因素(p53，肿瘤尺寸，和肿瘤有丝分裂) 的联合比任何单个因素提供预后的更强大的预言。

AIM： TO elucidate the prognostic role and relationship of three molecular markers such as tumor suppressor gene p53, proliferating cell nuclear antigen （PCNA） and Ki-67 in gastric stromal tumor. METHODS： A total of 108 surgically resected gastric smooth muscle tumor specimens were collected from January 1987 to December 1999. Immunohistochemical studies were performed on the paraffin sections of 99 of 108 CDl17-positive tumors with antibodies of p53, PCNA, and Ki-67. Immunoreactivity of three molecular markers was recorded by labeling index （LI, %） and was analyzed for clinicopathologic and survival correlation. RESULTS： Of the 99 cases, immunostaining revealed that 52 patients （52.5%） had p53, and 37 patients （37.3%） had Ki-67 immunoreactivity （defined as 〉10% of LI）. All patients （100%） had PCNA immunoreactivity ranging from 12% to 93% of LI, divided into high or low by median. Statistics revealed that LI of three markers positively correlate to each other （P〈0.01） and to microscopic tumor mitotic counts （P〈0.001）. By combination, patients with ≥2 markers （positive or high） in tumors had early tumor recurrence （P〈0.001） and unfavorable outcome （P〈0.001）. Univariate analysis indicated that patients with tumor size 〉5 cm （P=0.003）, tumor mitosis 〉5/50 HPF （P〈0.001）, p53 immunoreactivity （P=0.001）, Ki-67 immunoreactivity （P=0.026）, high PCNA LI （P=0.015） and male gender （P=0.036） were six predictors for early disease recurrence. Subsequent multivariate analysis revealed that mitotic counts, tumor size, and p53 immunoreactivity were three independent prognostic factors for both disease free and overall survival of patients. By combination of three independent prognostic factors for grouping, we found higher tumor recurrence rate （P〈0.001） and shorter survival （P〈0.001） existed in groups with increasing factors. CONCLUSION： We first provide the prognostic value and linkage of three molecular markers in GISTs. The combination of three factors （p53, tumor size, and tumor mitosis） provides a more powerful prediction of prognosis than any single factor does.