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Expression of p53 and Proliferation Index as Prognostic Factors in Gastrointestinal Sarcomas

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Abstract

Background:Sarcomas arising in the gastrointestinal (GI) tract are rare tumors. Molecular markers could be associated with prognosis in these types of tumors.

Methods:We performed a retrospective analysis of adult patients with sarcomas arising in the GI tract at the National Institute of Medical Sciences in Mexico City and the University of Alabama at Birmingham Hospital. All histological types were included. Patient, tumor, and treatment factors were analyzed, with overall survival as the main outcome variable. Expression of p53 and cellular proliferation antigen Ki-67 was also analyzed. Statistical analysis was performed by log-rank test and Cox regression. Significance was defined as P < .05.

Results:Forty-seven patients were analyzed. The median patient age was 53 years (range, 16–82 years). Twenty-five patients (53%) were women. The stomach was the most common site of presentation. The mean tumor size was 14 cm (2–45 cm). A complete resection was achieved in 40 patients. With a median follow-up of 30 months, the actuarial 3-year survival was 68%. Univariate analysis identified overexpression of p53 and Ki-67, high tumor grade, tumor size >10 cm, and incomplete resection as significant negative prognostic factors. Hispanic race and good performance status were significantly associated with prolonged survival. On multivariate analysis, overexpression of p53 was the only independent negative prognostic factor.

Conclusions:Overexpression of p53 is the strongest predictor of poor prognosis in patients with sarcomas of the GI tract.

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REFERENCES

  1. Medina-Franco H, Eltoum IE, Urist MM, Heslin MJ. Primary gastrointestinal sarcomas. Am Surg 2000; 66: 1–5.

    Google Scholar 

  2. Akwari OE, Dozois RR, Weiland LH, Beahrs OH. Leiomyosarcomas of the small and large bowel. Cancer 1978; 42: 1375–84.

    CAS  PubMed  Google Scholar 

  3. Evans HL. Smooth muscle tumors of the gastrointestinal tract. Cancer 1985; 58: 2242–50.

    Google Scholar 

  4. Zollinger RM, Sternfeld WC, Schreiber H. Primary neoplasms of the small intestine. Am J Surg 1986; 151: 654–8.

    PubMed  Google Scholar 

  5. McGrath PC, Neifield JP, Lawrence W Jr, et al. Gastrointestinal sarcomas: analysis of prognostic factors. Ann Surg 1987; 206: 706–10.

    CAS  PubMed  Google Scholar 

  6. Dougherty MJ, Compton C, Talbert M, Wood WC. Sarcomas of the gastrointestinal tract: separation into favorable and unfavorable prognostic groups by mitotic count. Ann Surg 1991; 214: 569–74.

    CAS  PubMed  Google Scholar 

  7. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors. Recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231: 51–8.

    Article  CAS  PubMed  Google Scholar 

  8. Blanke CD, von Mehren M, Joensuu H, et al. Evaluation of the safety and efficacy of an oral molecularly-targeted therapy, STI571, in patients with unresectable or metastatic gastrointestinal stromal tumors (GISTS) expressing c-kit (CD117). Proc Am Soc Clin Oncol 2001; 20: 2.

    Google Scholar 

  9. Van Oosterom AT, Judson I, Verweij J, et al. STI571, an active drug in metastatic gastrointestinal stromal tumors (GIST), an EORTC phase I Study. Proc Am Soc Clin Oncol 2001; 20: 2.

    Google Scholar 

  10. Heslin MJ, Cordon-Cardo C, Lewis JJ, Woodruff JM, Brennan MF. Ki-67 detected by MIB-1 predicts distant metastasis and tumor mortality in primary, high-grade extremity soft tissue sarcoma. Cancer 1998; 83: 490–7.

    Article  CAS  PubMed  Google Scholar 

  11. Sanders L, Silverman M, Rossi R, Braasch J, Munson L. Gastric smooth muscle tumors: diagnostic dilemmas and factors affecting outcome. World J Surg 1996; 20: 992–5.

    CAS  PubMed  Google Scholar 

  12. Ludwig DJ, Traverso LW. Gut stomal tumors and their clinical behavior. Am J Surg 1997; 173: 390–4.

    CAS  PubMed  Google Scholar 

  13. Lewin KJ, Riddel RH, Weinstein WM, eds. Gastrointestinal Pathology and Its Clinical Implications. New York: Igaku-Shoin Medical Publishers, 1992: 299–301.

  14. Al-Jaberi TM, Al-Masri N, Tubukhi A. Adult rhabdomyosarcoma of the gallbladder: case report and review of published works. Gut 1994; 35: 854–6.

    CAS  PubMed  Google Scholar 

  15. Conlon KC, Casper ES, Brennan MF. Primary gastrointestinal sarcomas: analysis of prognostic factors. Ann Surg Oncol 1995; 2: 26–31.

    CAS  PubMed  Google Scholar 

  16. Ng EG, Pollock RE, Munsell MF, et al. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Ann Surg 1992; 215: 68–77.

    Article  CAS  PubMed  Google Scholar 

  17. Daly MB, Clark GM, McGwire WM. Breast cancer prognosis in a mixed Caucasian-Hispanic population. J Natl Cancer Inst 1985; 74: 753–6.

    CAS  PubMed  Google Scholar 

  18. Elledge RM, Clark GM, Chamness GC, et al. Tumor biologic factors and breast cancer prognosis among white, Hispanic and black women in the United States. J Natl Cancer Inst 1994; 86: 705–9.

    CAS  PubMed  Google Scholar 

  19. Gordon NH, Crowe JP, Brumberg DJ, et al. Socioeconomic factors and race in breast cancer recurrence and survival. Am J Epidemiol 1992; 135: 609–15.

    CAS  PubMed  Google Scholar 

  20. Gerdes J. Ki-67 and other proliferation markers useful for immunohistological diagnostic and prognostic evaluations in human malignancies. Semin Cancer Biol 1990; 1: 199–206.

    CAS  PubMed  Google Scholar 

  21. Drobnjak M, Latres E, Pollack D, et al. Prognostic implications of p53 nuclear overexpression and high proliferation index of Ki-67 in adult soft tissue sarcomas. J Natl Cancer Inst 1994; 86: 549–54.

    CAS  PubMed  Google Scholar 

  22. Choong PF, Akerman M, Willen H, et al. Prognostic value of Ki-67 expression in 182 soft tissue sarcomas. Proliferation—a marker of metastasis? APMIS 1994; 102: 915–24.

    Article  CAS  PubMed  Google Scholar 

  23. Reich NC, Oren M, Levine AJ. Two distinct mechanisms regulate the levels of a cellular tumor antigen, p53. Mol Cell Biol 1983; 3: 2143–50.

    CAS  PubMed  Google Scholar 

  24. Cordon-Cardo C, Lares E, Drobnjak M, et al. Molecular abnormalities of mdm2 and p53 genes in adult soft tissue sarcomas. Cancer Res 1994; 54: 794–9.

    CAS  PubMed  Google Scholar 

  25. Leach FS, Tokino T, Meltzer P, et al. p53 mutation and MDM2 amplification in human soft tissue sarcomas. Cancer Res 1993; 53 (Suppl): 2231–4.

    CAS  PubMed  Google Scholar 

  26. Andreassen A, Oyjord T, Hovig E, et al. p53 abnormalities in different subtypes of human sarcomas. Cancer Res 1993; 53: 468–71.

    CAS  PubMed  Google Scholar 

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Correspondence to Heriberto Medina-Franco MD.

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Medina-Franco, H., la Medina, A.RD., Cortes-Gonzalez, R. et al. Expression of p53 and Proliferation Index as Prognostic Factors in Gastrointestinal Sarcomas. Ann Surg Oncol 10, 190–195 (2003). https://doi.org/10.1245/ASO.2003.03.033

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  • DOI: https://doi.org/10.1245/ASO.2003.03.033

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