| Objectives:(1)To discuss factors related to clinical characteristics, pathology, immunohistochemistry, biological behavior, and prognosis in gastric stromal tumors (GST).(2)To study the immunohistochemistry expression and clinical significance of DOG1in gastric stromal tumors. And to explore clinical significance of immunohistochemistry of GIST and compare it with CD117and CD34. To provide useful evidence for GST pathological diagnosis and clinical treatment.(3)Through detecting DOG1, CD117, and CD34in GST and comparing malignancy potential grading among Uyghurs and Hans in Xinjiang UyghurAutonomous Region, we want to find differences among two groups and its clinical significance. Methods:(1) We retrospectively analyzed70GST patients diagnosed after surgery and pathological examinations. All patients were treated at Peoples Hospital of Xinjiang Uyghur Autonomous Region from January2007until October2012. Clinical materialwere collected, and patients were contacted by telephone or mail for follow-up. We also analyzed effects of GST biological characteristics, diagnosis, treatment, age, sex, presenting symptoms, tumor location, tumor size, tumor rupture, mitosis, surgery, pathology, immunohistochemistry, and malignancy potential grading on prognosis.(2) Using immunohistochemistry Envision method, we tested DOG1expression among73patients who have confirmed diagnosis with surgery and pathological samples, and tested the value of DOG1in diagnosing GIST.(3) We enrolled both Uyghur and Han62patients from selective surgery, pathologically proven GST cases with full record. DOG1was tested with immunohistochemistry Envision method. We compared with DOG1, CD117, CD34between Uyghur and Han in terms of expression, tumor behavior such as malignancy potential grading. We analyzed differences among ethnic groups, and comparatively tested survival and prognosis in both groups. Results:(1)Among70GST cases, positivity rate of CD117、CD34、SMA、S-100, and Ki-67are94.3%(66/70)、91.4%(64/70)、38.6%(27/70)、24.3%(17/70)、84.3%(59/70) respectively; immunohistrochemistries were not associated with age, sex, tumor location, tumor size, mitosis, and malignancy potential grading (P>0.05).(2)CD117、CD34、SM4、 S-100,and Ki-67are important in diagnosing and differential diagnosis of GST, especially CDl17is a routine test. However, above indicators are not related to prognosis (P>0.05).(3)Age, sex, presenting symptom, tumor location of GST patients were not related to prognosis (P>0.05). However, tumor size, mitosis count, and malignancy potential grading were associated with prognosis. Especially, tumor size and mitosis count were independent predictors of prognosis.(4)DOG1positivity rate of73cases of GIST is91.78%(67/73), but in26non-GIST patients, it is only11.5%(3/26). When diagnosing GIST, especially CD117negative GIST, DOG1can be complementary and increase the accuracy of diagnosis, and can be used as routine immunohistochemistry test.(5)DOG1is expressed in GIST, and is not related to age, sex, tumor location, tumor size, mitosis, and malignancy potential grading of GIST patients (P>0.05).(6)DOG1is not related to GIST prognosis, and cannot be used as predictor of prognosis.(7)Among GST patients, gender is different between Uyghurs and Han (P<0.05), there are more male GST patients among Uyghurs than Han.(8)DOG1、CD117、CD34expression among Han and Uyghur patients are91.67%(44/48)、93.75%(45/48)、91.67%(44/48), and92.86%(13/14)、92.86%(13/14)、92.86%(13/14), respectively and no differences were observed (P>0.05).(9)Tumor size, mitosis, and malignancy potential grading were associated with prognosis among Uyghurs as well as Hans (P<0.05), but no differences were detected when comparing both ethnic groups. Conclusions:(1)Male to female ratio in GST is1.06:1, more males had GST than females. Disease age occurred mostly between50and69, median age is59.1. Most common clinical manifestation is abdominal distension, followed by gastrointestinal hemorrhage and abdominal mass. There is a lack of specificity of clinical manifestations.(2)Most common GST tumor location is gastric body, followed by antrum and fundus. Most GST patients were diagnosed after ultrasonography, and immunohistrochemistry is a standard practice in GST, especially CD117. Detection of SMA and S-100by immunohistochemistry is helpful in diagnosis and differential diagnosis of GST patients.(3)When diagnosing GIST, DOG1has high sensitivity and high specificity as CD117. Especially for CD117negative cases, DOG1can be a complementary test that can reduce the rate of misdiagnosis. DOG1can be recommended as a immunohistochemistry test for GIST, together with CDl17and CD34, DOG1greatly increased the diagnostic accuracy.(4)DOG1cannot be used for discrimination of malignant tendency, tumor size and mitosis index should be considered for predicting malignancy in GST.(5)It would be reasonable, scientific, simple and feasible to use NIH malignancy potential grading to predict biological behavior of GST. Tumor size and mitosis index are independent factors that related to GST prognosis.(6)GST prognosis is not related to sex, age, tumor location, presenting symptom and expression of numerous factors (DOG1、CD117、CD34、SMA S-100、and Ki67).(7)Surgery is the first line treatment for primary GST, the crucial step is to root out the tumor with the first surgery.(8)More GST patients were observed among Uyghur men compared to Han. In both groups, tumor size, mitosis index, and malignancy potential were related to prognosis. But survival was not affected by ethnicity.(9)Among Uyghurs and Hans, no significant differences were detected in terms of DOG1、CD117, and CD34expression in GST. At the same time, prognosis was similar among ethnic groups. |
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