Expression Of CD133in Gastrointestinal Stromal Tumors And Prognostic Significance

Objective:To improve the clinical cure rate and improve the quality of life for patients of gastrointestinal stromal tumors (GIST), explore the prognostic factors of GIST, investigate the expression of CD133in GIST and the relationship with survival prognosis.Methods:CD133was detected in105cases with GIST, operated in Shanghai Cancer Fudan university Shanghai Cancer centerfrom January2006to September2010, using immunohistochemical technique. All the patients reviewed and the prognosis factors were evaluated. Kaplan-Meier method was used for survival rates. Prognosis and variables was analyzed by Log-rank test. In the test, P<0.05was statistically significant. Cox Proportional hazards regression survival analysis was used for Multivariate analysis.Result:There are105cases in this group, male to female ratio of,1.2:1(58/47),age from27to79years, median age54years. Primary tumor sites were mainly distributed in the stomach53cases(50.5%), small bowel29cases(27.6%), colorectal12cases(11.4%), abdominal cavity and GIST with unknown primary site11cases (10.5%), the maximum diameter from0.5cm to more than22cm,median diameter9cm.GIST lesions numbers were distributed in single84cases (80.0%),two7cases(6.7%),three and more14cases(13.3%).The number of mitotic were distributed in≤5/50HP65cases (61.9%),from6to10were27cases(25.7%),more than10were13cases(12.4%). Primary GIST and recurrence and metastasis GIST were82(78.1%) cases and23cases (21.9%). NIH risk group was distributed in group Ⅰ5cases (4.8%), group Ⅱ24 cases (22.9%), group III10cases (9.5%), group IV66cases (62.9%). CD117were expressed in99cases (94.3%). CD34were expressed in77cases (73.3%). CD133were low expressed in16cases (15.2%), with high expresses3cases (2.9%). There was statistical significance in the expression among the location of GIST, with P=0.038. The CD133was higher expressed in abdominal cavity and unknown primary site. Also, CD133were higher expressed in group IV of NIH with statistical significance (P<0.05).Radical surgical excision is performed in90cases (85.7%), laparotomy exploratory and biopsy procedures in6cases (5.7%), palliative resection in9cases (9.6%).The primary gastrointestinal stromal tumors received radical surgical excision72cases, with non-radical operation10cases (12.2%). There were23cases of (?)ecurrence and metastasis GIST, which accepted radical surgical excision18cases (78.3%), non-radical operation5cases (21.7%).41cases were received the greater omentum radical excision. The bleeding volume during operation was between20ml to10000ml, median480ml. The max amount of blood transfusion is12600ml, median460ml.5cases of primary GIST received neoadjuvant therapy of imatinib mesylate, the medication duration from3months to12months.51patients received imatinib mesylate therapy after operation. The time for medication was from one year, two years, there years and more. The number were17cases (16.2%),16cases (15.2%),18cases (17.1%). Sunitinib is taken by3patients for the econd-line therapy after imatinib resistance. Clinical trials are for one patient because of the sunitinib resistance.18cases of recurrence and metastasis GIST (18/23) received postoperative imatinib. The recurrence and metastasis was significant differences in imatinib group and control group.Univariate analysis showed that:The whole group of1,3,5-year overall survival rates were95.9%、80.7%、59.1%。 The survival rate of patients by surgical procedure, the amount of blood transfusion, the maximum diameter(≤10cm、>10cm),CD133,CD34, the NIH risk (high-risk group and non-high-risk group) was statistical significance. Intermediate and high-risk GISTs are divided into two groups upon whether received adjuvant therapy of imatinib mesylate, the five-year overall survival rates are74.9%、44.3%, with statistical significance. The primary GISTs divided into two groups upon radical surgical excision, the five-year overall survival rates are85.2%、36.0%, with statistical significance. COX multivariate survival analysis showed NIH risk and surgical procedure to influence the prognosis of GIST independent risk factors for survival.Conclusions:1. Surgical approach and NIH risk group were the independent risk factors of prognosis in GIST, it highlight that high-risk group patients had worse prognosis, the radical surgical excision GISTs had better prognosis. So, the radical surgical excision was the best choice of the primary GISTs.2. Imatinib mesylate was suitable for the Intermediate and high-risk GISTs as adjuvant therapy, it can improve the survival and reduce the recurrence and metastasis.The recurrence and metastasis GISTs received imatinib mesylate after operation for a djuvant therapy can reduce the rate of recurrence and metastasis.3. The expression of CD133was higher in GIST of abdominal cavity and unknown primary site and high-risk group. There was no difference in age, gender, tumor size, mitotic count, recurrence and metastasis.4. CD133is not an independent prognostic factor in GIST. CD133-positive GIST patients had poor prognosis in this study, as CD133affect the prognosis related to higher expression in abdominal cavity and unknown primary site and high-risk group.