| ObjectiveIn our study we aim to explore the expression and clinical significance of caldesmon, a specific marker of smooth muscle differentiation, in GIST by combination of retrospective analysis of the clinical follow-up data and immunohistochemical analysis of caldesmon expression.Methods1.171 cases of GIST were collected from the Pathology Department of Tongji Hospital, Huazhong University of Science and Technology, all of surgically dissected tumors were diagnosied during January 2011 to December according to the GIST diagnosis standard. Their medical records were of great integrity.2.The smooth muscle cell differentiation were evaluated by immunohistochemical staining of smooth muscle cell markers such as desmin, caldesmon and SMA.3.Follow-up was done for all patients and information including medical treatment and recurrence et al. after discharge was recorded.4.The data were analyzed using Chi-squared test, Fisher's exact test and Spearman rank correlation with SPSS22.0 software. We performed the survival curves was analysis and generated Kaplan-Meier plot; univariate analysis on prognosis was done with Log-rank test,P < 0.05 indicates statistical significance?Results1.The general information1.1 Age: 21-85 years old, average age 55.1 ±11.0, the median age 57 years old; 1.2 Gender: male, 97 cases(56.7%); female, 74cases(43.4%). 1.3 Sites: stomach, 96 cases(56.1%); intestines, 60cases(35.1%); parenteral,15 cases(8.8%); 1.4 risk classification(NIH standard): the extreme low latent to low risk: 97cases(56.7%);Medium risk:19cases(11.1%)high-risk:55cases(32.2%); 1.5 Cell morphology: spindle cell type-143cases(83.6%) in; epithelioid cell type-16 cases(9.4%) in;mixed type- 12cases(7.0%).2.GIST diagnosed according to the criteria express SMA(25.1%), caldesmon(63.7%), desmin(6.4%).3.The expression levels of caldesmon is correlated with tumor size, primary site, nuclear fragmentation index, and risk classification(P < 0.05); but is not correlated with other clinical parameters such as age, gender, cell morphology, et al)(P > 0.05).4. Univariate analysis indicated that caldesmon expression, the sites of tumor, mitotic index, tumor size were significantly correlated with 3 year DFS(P < 0.05); Other clinical parameters including age, gender, cell morphology, et. al) are not correlated with 3 year DFS(P > 0.05).Multivariate analysis indicated that similar with the tumor location, tumor size and mitotic index, expression of caldesmon is an independent factors influencing 3 year DFS(P < 0.05)?Conclusions1. smooth muscle marker including desmin, caldesmon and SMA were partially expressed in GIST. The expression level of caldesmon is significantly higher than that of desmin and SMA in GIST.2. The expression level of caldesmon was associated with some clinical parameters including tumor size, location, mitotic rate, Risk Stratification that are important prognostic factors(P < 0.05),which suggested that caldesmon expression may be relevant to the prognosis of GISTs patient.univariate and multivariate analysis indicated that the disease free survival of GIST patients has a significant correlation with caldesmon expression as well as other well known prognostic factors- tumor size, the primary tumor site, the mitotic index and the risk classification(P < 0.05). Therefore smooth muscle differentiation demonstrated by caldesmon expression is associated with good prognosis of GIST.. |
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