Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2012; 18(14): 1664-1671
Published online Apr 14, 2012. doi: 10.3748/wjg.v18.i14.1664
Prognostic significance of PTEN, Ki-67 and CD44s expression patterns in gastrointestinal stromal tumors
Yu-Mei Liang, Xiang-Hong Li, Wen-Mei Li, You-Yong Lu
Yu-Mei Liang, Department of Pathology, Chinese PLA the 309th Hospital, Beijing 100091, China
Xiang-Hong Li, Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China
Wen-Mei Li, You-Yong Lu, Laboratory of Molecular Oncology, Peking University School of Oncology, Beijing Cancer Hospital/Institute, Beijing 100036, China
Author contributions: Li XH and Lu YY contributed equally to this work; Liang YM and Li WM performed the research; Liang YM, Li XH and Lu YY analyzed the data; Liang YM, Li XH and Lu YY wrote the paper.
Supported by Grants from the National Key Basic Research Program Project of China, No.2004CB518708; National Bio-Tech 863 program, No. 2002-BA711 A11
Correspondence to: You-Yong Lu, MD, Professor of Medicine, Chief, Laboratory of Molecular Oncology, Peking University School of Oncology, Beijing Cancer Hospital/Institute, 52 Fucheng Road, Beijing 100036, China.
Telephone: +86-10-88196765 Fax: +86-10-88122473
Received: August 30, 2011
Revised: January 16, 2012
Accepted: February 8, 2012
Published online: April 14, 2012

AIM: To develop a prognostic approach for gastrointestinal stromal tumors (GISTs) using a cluster of indicators and follow-up information.

METHODS: One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location. By immunohistochemistry, the expressions of PTEN, Ki-67, CD44s matrix metalloproteinase (MMP)-9 and TIMP-1 were detected on tissue microarray. Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.

RESULTS: Our data showed small intestinal GIST are more aggressive than gastric GIST. The NIH risk assessment correlated with disease-free survival for either gastric GIST or small intestinal GIST. Immunohistochemical analysis revealed that Ki-67 labeling indexes (LIs) < 5% predicted higher disease-specific survival (DSS) in gastric and small intestinal GIST. CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST. MMP-9 and TIMP-1 had no correlation with survival. Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST (P = 0.009), as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST (P = 0.011). Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.

CONCLUSION: PTEN LIs ≥ 50%, Ki-67 LIs < 5% and CD44s positivity provides an accurate, favorable prognosis for gastric GIST. PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST. Ki-67 LIs enhances the NIH assessment.

Keywords: Gastrointestinal stromal tumor, Prognosis, PTEN, Ki-67, CD44s