IMMUNOPHENOTYPE, PROLIFERATION, DNA-PLOIDY, AND BIOLOGICAL BEHAVIOR OF GASTROINTESTINAL STROMAL TUMORS - A MULTIVARIATE CLINICOPATHOLOGICALSTUDY

To determine the prognostic impact of clinical, immunohistochemical, a nd biological parameters, we examined 52 gastrointestinal stromal tumo rs (GIST) by conventional light microscopy and immunohistochemistry. D NA ploidy was analyzed by image cytometry on cytospin preparation. The proliferative activity was determined by mitosis counting and assessm ent of Ki-67 reactivity by means of monoclonal antibody Ki-S5. A histo pathologic grade was assigned to each tumor according to the French Fe deration of Cancer Centers (FNCLCC) grading system. Next to vimentin, CD34 was the most prevalent antigen, followed by markers of neural and muscular differentiation. Many tumors exhibited a mixed phenotype. Tw enty-one tumors were diploid, eight hypodiploid, and 23 aneuploid. In univariate analysis, tumor grade, Ki-S5 labeling index, mitotic count, atypical mitoses, cellularity, and sex were predictive of both mortal ity and metastasis risk. DNA ploidy only correlated with overall survi val, whereas the tumor location affected the occurrence of metastases. Multivariate analysis selected Ki-S5 scores (P < .0001) and atypical mitoses (P = .012) as independent prognosticators for overall survival , and tumor grade (P = .0036) and size (P = .0055) as predictors of me tastatic spread. We conclude that GIST are primitive mesenchymal tumor s capable of divergent differentiation, which does not influence their prognosis. The latter appears to be best predicted by histopathologic grading and the Ki-67 labeling index. Copyright (C) 1998 by W.B. Saun ders Company.