| Abstract | Primarni cilj provedenog istraživanja bio je procijeniti kako karakteristike bolesnika i primarnih tumora utječu na prognozu te koja od triju klasifikacija GIST-ova (Aminova, Newmanova ili Fletcherova) najbolje predviđa prognozu. NACRT STUDIJE Studija je obuhvatila bolesnike koji su zbog GIST-ova probavnog sustava kirurški liječeni u Klinici za tumore od 1. siječnja 1995. do 31. prosinca 2011. godine. Procjenjivalo se kako karakteristike bolesnika (životna dob, spol) i primarnih tumora (lokalizacija, imunohistokemijska izraženost CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) utječu na duljinu preživljenja i vjerojatnost smrtnog ishoda. ISPITANICI I METODE Ukupno 63 bolesnika s GIST-om bilo je klasificirano prema spolu i životnoj dobi. Tumori su bili klasificirani prema lokalizaciji i prema Aminovoj, Newmanovoj i Fletcherovoj klasificikaciji te je na svima imunohistokemijski određena izraženost određenih proteina (CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1). REZULTATI Raspodjela prema spolu bila je ravnomjerna (49,2 % (31/63) muškarci vs 50,8 % (32/63) žene) bez značajne razlike u prosječnoj životnoj dobi, duljini preživljenja i vjerojatnosti smrtnog ishoda. Bolesnici s primarnim GIST-om omentuma imali su veću vjerojatnost umiranja u odnosu na bolesnike s primarnim tumorima želuca (p = 0,003) bez značajne razlike u duljini preživljenja (p = 0,061). Uočena je pozitivna povezanost vjerojatnosti smrtnog ishoda i stupnja zloćudnosti prema Aminovoj, Newmanovoj te Fletcherovoj klasifikaciji. Što je tumor pripadao zloćudnijoj skupini, postojala je veća vjerojatnost smrtnog ishoda. Bolesnici s dobroćudnim i niskorizičnim tumorima su značajno dulje živjeli u odnosu na bolesnike s agresivnijim tumorima. Nije zabilježena značajna razlika između triju klasifikacijskih sustava (Aminove, Newmanove i Fletcherove klasifikacije) u predviđanju smrtnog ishoda i duljine preživljenja. Postojanje metastaza u trenutku dijagnoze najlošiji je prognostički čimbenik. Imunohistokemijska izraženost niti jednog ispitivanog proteina (CD 117, CD34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) nije bila povezana sa smanjenom ili povećanom vjerojatnosti smrtnog ishoda bolesnika. Bolesnici sa S-100 pozitivnim GIST-ovima značajno su kraće živjeli u odnosu na bolesnike s negativnim S-100 GIST-ovima (24 mjeseca vs 39 mjeseci, p = 0,034). ZAKLJUČAK Prognoza GIST-ova može se odrediti na temelju njihovih morfoloških i lokalizacijskih karakteristika, a bez uporabe skupih i složenih imunohistokemijskih obrada. |
| Abstract (english) | AIM Primary study aim was to estimate how patients' and tumors' characteristics influence prognosis and which of GISTs' classification systems (Amin's, Newman's, Fletcher's) is optimal in predicting prognosis. STUDY DESIGN Study comprised patients surgically treated for gastrointestinal GISTs at the Unversity Hospital for Tumors since 01.01.1995. untill 31.12.2011. Estimation of tumors' (localization, immunohystochemical expression of CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) and patients' characteristics (age, gender) influence on survival and possibility of dying was done. PATIENTS AND METHODS Study comprised 63 GIST patients. Patients were classified according to age and gender. Tumors were classified according to localization. Considering pathohystological characteristics which defined malignant potential of tumors, they were classified according to Amin's, Newman's and Fletcher's classification. All tumors specimens were immunohystochemically stained with CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1. RESULTS Patients' distribution according to gender was even (49,2 % (31/63) men vs 50,8 % (32/63) women), with no significant difference in average age, survival or possibility of dying. Patients with primary omental GISTs had greater possibility of dying then patients with primary gastric GISTs (p = 0,003), with no significant difference in survival lenght (p = 0,061). Positive correlation between possibility of dying and malignancy grade according to Amin's, Newman's and Fletcher' classification was observed. The higher malignancy grade was correlated with higher possibility of dying. Patients with benign and low risk tumors lived significantly longer in comparison with patients with more aggressive tumors. There was no difference between three classification systems in predicting survival and possibility in dying. The existance of metastatic disease at diagnosis is the worst prognostic factor. Immunohystochemic expression of none of investigated proteins (CD 117, CD 34, vimentin, SMA, S-100, MAGE A1, MAGE A3/4, NY ESO 1) was associated with diminished or increased possibility of dying. Patients with S-100 positive GISTs lived significantly shorter comparing to those with S-100 negative tumors (24 vs 39 months, p = 0,034). CONCLUSION GISTs prognosis can be deteremined considering morphologic characteristics and localization of tumors, with no additional need for expensive and complicated immunohystochemical studies. |
