Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors: Correlation with mitotic count and clinical outcome

Mahul Amin, C. K. Ma, M. D. Linden, J. J. Kubus, R. J. Zarbo

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Abstract

Morphologic studies of gastric stromal tumors (GSTs) indicate that mitotic counts (MCs) and tumor size are major discriminants predictive of biologic behavior. The authors evaluated the tumor proliferation of GSTs with anti- proliferating cell nuclear antigen (PCNA; DAKO clone PC10, DAKO Corporation, Carpinteria, CA) for correlation with MCs, histologic cell type, and clinical outcome. Fifty-eight tumors ranging from 1.5 to 45 cm in size were selected for clinicopathologic assessment. Mitotic activity was counted per 50 high- power fields (MC). For this study, combined parameters of MC and tumor size were used to categorize tumors into three groups: (1) benign: MC less than 5, tumor smaller than 5 cm; (2) borderline: MC less than 5, tumor larger than 5 cm; and (3) malignant: MC greater than 5, tumor any size. The PCNA tumor proliferation index (TPI) was assessed from evaluation of 200 tumor cells per case and expressed as the percentage of cells with positive results. Clinical follow-up was available in 45 cases. None of the 19 benign or 16 borderline tumors recurred or metastasized, whereas 7 of 10 malignant tumors metastasized and 1 of 10 recurred. The mean PCNA TPI values among benign (11.2%), borderline (16%), and malignant (34.5%) tumors were significantly different (P = 0.0002, Kruskal-Wallis test). When the pathologic tumor categories were compared, the mean TPI of benign tumors was significantly different from that of borderline tumors (P = 0.0306, Kruskal-Wallis), and the TPI of borderline tumors was different from that of the malignant tumors (P = 0.0060, Kruskal-Wallis test). The Spearman rank correlation showed a significant relationship between the MC and PCNA TPI (P = 0.0003, r = 0.4543). Logistic regression analysis showed that the TPI, independent of MC and size, contributed significantly (P = 0.00295) to the prediction of outcome. In the malignant group, the mean TPI for malignant tumors with metastases (43.6%) was significantly different (P = 0.0411, Kruskal-Wallis test) from that of malignant tumors without metastases (including the case with probable recurrence) (11.83%). No correlation was found when PCNA TPIs for epithelioid GCTs were compared with those of spindle cell GSTs. The authors conclude the following: (1) the PCNA-derived TPI correlates with the MC and is an additional independent prognostic parameter in the assessment of GSTs; (2) higher PCNA TPIs in histologically malignant GSTs may correlate with metastasis and clinical outcome; (3) in GSTs with an MC less than 5, the PCNA TPI provides a quantitative parameter to potentially separate borderline from benign tumors; and (4) the intermediate PCNA TPI of borderline tumors defined by size further justifies separation of GSTs into benign, borderline, and malignant categories.

Original languageEnglish (US)
Pages (from-to)428-432
Number of pages5
JournalAmerican Journal of Clinical Pathology
Volume100
Issue number4
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

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Proliferating Cell Nuclear Antigen
Stomach
Neoplasms

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine

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Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors : Correlation with mitotic count and clinical outcome. / Amin, Mahul; Ma, C. K.; Linden, M. D.; Kubus, J. J.; Zarbo, R. J.

In: American Journal of Clinical Pathology, Vol. 100, No. 4, 01.01.1993, p. 428-432.

Research output: Contribution to journalArticle

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abstract = "Morphologic studies of gastric stromal tumors (GSTs) indicate that mitotic counts (MCs) and tumor size are major discriminants predictive of biologic behavior. The authors evaluated the tumor proliferation of GSTs with anti- proliferating cell nuclear antigen (PCNA; DAKO clone PC10, DAKO Corporation, Carpinteria, CA) for correlation with MCs, histologic cell type, and clinical outcome. Fifty-eight tumors ranging from 1.5 to 45 cm in size were selected for clinicopathologic assessment. Mitotic activity was counted per 50 high- power fields (MC). For this study, combined parameters of MC and tumor size were used to categorize tumors into three groups: (1) benign: MC less than 5, tumor smaller than 5 cm; (2) borderline: MC less than 5, tumor larger than 5 cm; and (3) malignant: MC greater than 5, tumor any size. The PCNA tumor proliferation index (TPI) was assessed from evaluation of 200 tumor cells per case and expressed as the percentage of cells with positive results. Clinical follow-up was available in 45 cases. None of the 19 benign or 16 borderline tumors recurred or metastasized, whereas 7 of 10 malignant tumors metastasized and 1 of 10 recurred. The mean PCNA TPI values among benign (11.2{\%}), borderline (16{\%}), and malignant (34.5{\%}) tumors were significantly different (P = 0.0002, Kruskal-Wallis test). When the pathologic tumor categories were compared, the mean TPI of benign tumors was significantly different from that of borderline tumors (P = 0.0306, Kruskal-Wallis), and the TPI of borderline tumors was different from that of the malignant tumors (P = 0.0060, Kruskal-Wallis test). The Spearman rank correlation showed a significant relationship between the MC and PCNA TPI (P = 0.0003, r = 0.4543). Logistic regression analysis showed that the TPI, independent of MC and size, contributed significantly (P = 0.00295) to the prediction of outcome. In the malignant group, the mean TPI for malignant tumors with metastases (43.6{\%}) was significantly different (P = 0.0411, Kruskal-Wallis test) from that of malignant tumors without metastases (including the case with probable recurrence) (11.83{\%}). No correlation was found when PCNA TPIs for epithelioid GCTs were compared with those of spindle cell GSTs. The authors conclude the following: (1) the PCNA-derived TPI correlates with the MC and is an additional independent prognostic parameter in the assessment of GSTs; (2) higher PCNA TPIs in histologically malignant GSTs may correlate with metastasis and clinical outcome; (3) in GSTs with an MC less than 5, the PCNA TPI provides a quantitative parameter to potentially separate borderline from benign tumors; and (4) the intermediate PCNA TPI of borderline tumors defined by size further justifies separation of GSTs into benign, borderline, and malignant categories.",
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T1 - Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors

T2 - Correlation with mitotic count and clinical outcome

AU - Amin, Mahul

AU - Ma, C. K.

AU - Linden, M. D.

AU - Kubus, J. J.

AU - Zarbo, R. J.

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N2 - Morphologic studies of gastric stromal tumors (GSTs) indicate that mitotic counts (MCs) and tumor size are major discriminants predictive of biologic behavior. The authors evaluated the tumor proliferation of GSTs with anti- proliferating cell nuclear antigen (PCNA; DAKO clone PC10, DAKO Corporation, Carpinteria, CA) for correlation with MCs, histologic cell type, and clinical outcome. Fifty-eight tumors ranging from 1.5 to 45 cm in size were selected for clinicopathologic assessment. Mitotic activity was counted per 50 high- power fields (MC). For this study, combined parameters of MC and tumor size were used to categorize tumors into three groups: (1) benign: MC less than 5, tumor smaller than 5 cm; (2) borderline: MC less than 5, tumor larger than 5 cm; and (3) malignant: MC greater than 5, tumor any size. The PCNA tumor proliferation index (TPI) was assessed from evaluation of 200 tumor cells per case and expressed as the percentage of cells with positive results. Clinical follow-up was available in 45 cases. None of the 19 benign or 16 borderline tumors recurred or metastasized, whereas 7 of 10 malignant tumors metastasized and 1 of 10 recurred. The mean PCNA TPI values among benign (11.2%), borderline (16%), and malignant (34.5%) tumors were significantly different (P = 0.0002, Kruskal-Wallis test). When the pathologic tumor categories were compared, the mean TPI of benign tumors was significantly different from that of borderline tumors (P = 0.0306, Kruskal-Wallis), and the TPI of borderline tumors was different from that of the malignant tumors (P = 0.0060, Kruskal-Wallis test). The Spearman rank correlation showed a significant relationship between the MC and PCNA TPI (P = 0.0003, r = 0.4543). Logistic regression analysis showed that the TPI, independent of MC and size, contributed significantly (P = 0.00295) to the prediction of outcome. In the malignant group, the mean TPI for malignant tumors with metastases (43.6%) was significantly different (P = 0.0411, Kruskal-Wallis test) from that of malignant tumors without metastases (including the case with probable recurrence) (11.83%). No correlation was found when PCNA TPIs for epithelioid GCTs were compared with those of spindle cell GSTs. The authors conclude the following: (1) the PCNA-derived TPI correlates with the MC and is an additional independent prognostic parameter in the assessment of GSTs; (2) higher PCNA TPIs in histologically malignant GSTs may correlate with metastasis and clinical outcome; (3) in GSTs with an MC less than 5, the PCNA TPI provides a quantitative parameter to potentially separate borderline from benign tumors; and (4) the intermediate PCNA TPI of borderline tumors defined by size further justifies separation of GSTs into benign, borderline, and malignant categories.

AB - Morphologic studies of gastric stromal tumors (GSTs) indicate that mitotic counts (MCs) and tumor size are major discriminants predictive of biologic behavior. The authors evaluated the tumor proliferation of GSTs with anti- proliferating cell nuclear antigen (PCNA; DAKO clone PC10, DAKO Corporation, Carpinteria, CA) for correlation with MCs, histologic cell type, and clinical outcome. Fifty-eight tumors ranging from 1.5 to 45 cm in size were selected for clinicopathologic assessment. Mitotic activity was counted per 50 high- power fields (MC). For this study, combined parameters of MC and tumor size were used to categorize tumors into three groups: (1) benign: MC less than 5, tumor smaller than 5 cm; (2) borderline: MC less than 5, tumor larger than 5 cm; and (3) malignant: MC greater than 5, tumor any size. The PCNA tumor proliferation index (TPI) was assessed from evaluation of 200 tumor cells per case and expressed as the percentage of cells with positive results. Clinical follow-up was available in 45 cases. None of the 19 benign or 16 borderline tumors recurred or metastasized, whereas 7 of 10 malignant tumors metastasized and 1 of 10 recurred. The mean PCNA TPI values among benign (11.2%), borderline (16%), and malignant (34.5%) tumors were significantly different (P = 0.0002, Kruskal-Wallis test). When the pathologic tumor categories were compared, the mean TPI of benign tumors was significantly different from that of borderline tumors (P = 0.0306, Kruskal-Wallis), and the TPI of borderline tumors was different from that of the malignant tumors (P = 0.0060, Kruskal-Wallis test). The Spearman rank correlation showed a significant relationship between the MC and PCNA TPI (P = 0.0003, r = 0.4543). Logistic regression analysis showed that the TPI, independent of MC and size, contributed significantly (P = 0.00295) to the prediction of outcome. In the malignant group, the mean TPI for malignant tumors with metastases (43.6%) was significantly different (P = 0.0411, Kruskal-Wallis test) from that of malignant tumors without metastases (including the case with probable recurrence) (11.83%). No correlation was found when PCNA TPIs for epithelioid GCTs were compared with those of spindle cell GSTs. The authors conclude the following: (1) the PCNA-derived TPI correlates with the MC and is an additional independent prognostic parameter in the assessment of GSTs; (2) higher PCNA TPIs in histologically malignant GSTs may correlate with metastasis and clinical outcome; (3) in GSTs with an MC less than 5, the PCNA TPI provides a quantitative parameter to potentially separate borderline from benign tumors; and (4) the intermediate PCNA TPI of borderline tumors defined by size further justifies separation of GSTs into benign, borderline, and malignant categories.

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