RE: Antikörper/Prof.Wust
Nachtrag: Ergänzend habe ich Ihnen noch einige Medline-Auszüge zum GIST beigefügt. Es ist ein sehr seltener Tumor, der mehr einem Weichteilsarkom ähnelt. Große Fallzahlen sind nicht publiziert. Über Behandlungen mit einem Antikörper sind jüngste ermutigende Daten publiziert. Die Operation ist dennoch eine wichtige Therapie. Sicher kann man auch eine AK-Therapie davorschalten. Vermutlich haben Sie mit Ihrer Skepsis etwas recht, aber man sollte alles versuchen. Wie gesagt, eine Operation an der Leber kann auch nachgeschaltet werden, wenn der Tumor auf die AK-Therapie nicht anspricht.
TI: Gastrointestinal stromal tumor workshop.
AU: Berman,-J; O'Leary,-T-J
AD: Cancer Diagnosis Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
SO: Hum-Pathol. 2001 Jun; 32(6): 578-82
*LHM: Volltext ab 32 (2001) -> siehe Homepage der Bibliothek
Mitte : Pathologie : 22 (1991) -
Sign: Z 13 /062
IS: 0046-8177
PY: Inde
LA: English
CP: United-States
AB: Gastrointestinal stromal tumor (GIST) has emerged in the past year as a prototypical neo-plasm that responds to therapy directed against a single target molecule-the KIT receptor tyrosine kinase protein. Although GIST seldom responds to conventional chemotherapeutic agents, early experience with the tyrosine kinase inhibitor, STI-571 (Gleevec; Novartis, Basel, Switzerland), has been extremely encouraging. Early results have appeared in a recent case report in the New England Journal of Medicine (April 5, 2001),(1) and in early clinical trials from the United States and Europe that were reported at the plenary session of the American Society of Clinical Oncology in San Francisco on May 14, 2001. STI-571 is one of the earliest examples of a nontoxic chemotherapeutic agent (an agent whose anti-cancer activity is not predicated on a cytotoxic mechanism). STI-571 has already shown clinical value in BCR-ABL-positive leukemias. Early clinical results in GIST are so encouraging that oncologists may soon be wrestling with the opportunity of referring every patient with malignant GIST into clinical trials with STI-571. To en-sure appropriate treatment, pathologists need to understand the biology and treatment of this tumor and to have standard methods and criteria for providing diagnosis (GIST or not GIST) and consistent prognostic classification (high risk of metastasis or low risk of metastasis).
[Primary gastrointestinal stromal tumors]
AU: Wiener,-Y; Gold,-R; Zehavy,-S; Sandbank,-J; Halevy,-A
AD: Dept. of General Surgery, Israel.
SO: Harefuah. 2001 May; 140(5): 377-80, 456, 455
IS: 0017-7768
PY: 2001
LA: Hebrew; Non-English
CP: Israel
AB: Stromal tumors of the GI tract are rare. In the retrospective and prospective study we inve-stigated the relationship between tumor symptomatology, tumor grade and prognostic factors. During the period May 1993-September 1999, 11 female and 13 male patients with a mean age of 62 (range-29-81) years were operated for primary gastrointestinal stomal tumors (GIST) in our department. Observed signs and symptoms were: GI bleeding (65%), abdominal pain (45%), abdominal mass (15%) and weakness (5%). In 4 patients tumor was an incidental finding during investigation or operation for another tumor. Tumor location (in decreasing order) was: stomach (15), small bowel (SB, 6), esophagus (1), duodenum (1) and colon (1). Preoperative biopsy or FNA were diagnostic in less than 50% of the cases. Operative procedures included wedge re-section (8 patients), resection of segment of bowel (10) and extended resection (6), of dia-phragm, SB, colon, bladder, kidney and liver. The mean tumor size was 7.8 (range-0.9-22) cm. Four tumors were graded as benign, 8 of indeterminate malignant potential and 12 malignant. CONCLUSION: The main presentation of GIST is acute GI bleeding. Endoscopy is most effective for studying proximal tumors, and CT should be used to identify distal GI tract tumors. Tumor size or malignancy were not necessarily predictive of GI bleeding. When invasive to adjacent organs is present, wide excision should be contemplated as long-term survival can be achieved.
The effect of surgery and grade on outcome of gastrointestinal stromal tumors.
AU: Pierie,-J-P; Choudry,-U; Muzikansky,-A; Yeap,-B-Y; Souba,-W-W; Ott,-M-J
AD: Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
SO: Arch-Surg. 2001 Apr; 136(4): 383-9
*LHM: Volltext ab 133 (1998) 6 -> siehe Homepage der Bibliothek
Mitte : Chirurgie : 120 (1985) - 135 (2000)
Sign: Z 02 /049
Wedding : Med. Bibliothek : 55 (1947) - [L:55-57] [00:65]
Sign: Z XV 3
IS: 0004-0010
PY: 2001
LA: English
CP: United-States
AB: HYPOTHESIS: Gastrointestinal stromal tumors (GIST) are aggressive, rare, and difficult-to-cure gastrointestinal tumors. We believe that the clinical behavior of these tumors can be pre-dicted by reproducible prognostic factors. DESIGN AND SETTING: A retrospective review of all patients (N = 70) with GIST treated at a tertiary care center from 1973 to 1998. PATIENTS: Adequate data for evaluation were available for 69 patients. Male-female distribution was 40:29. Median age was 60 years. Median follow-up duration was 38 months. MAIN OUTCOME MEA-SURES: Tumor grade, stage, and histologic subtype at presentation; effect of grade, surgery and adjuvant therapy on recurrence, salvage, and survival. RESULTS: Tumor distribution included 61% in the upper, 23% in the middle, and 16% in the lower digestive tract, with a median tumor size of 7.9 cm (range, 1.8-25 cm). Tumors with more than 1 mitosis per 10 high-power fields constituted 57% of neoplasia in the series. Distant disease at initial visit occurred in 49% of patients. Complete gross resection occurred in 59% of patients. After complete resection, the 5-year survival rate was 42%, compared with 9% after incomplete resection (hazard ratio = 0.27, P<.001). Neither radiation nor chemotherapy demonstrated any significant benefit. Among 39 patients who were disease free after complete resection, 2% developed lymph node recurrence, 25% developed local recurrence, and 33% developed distant recurrences (54% liver, 20% peri-toneum). By multivariate analysis the risk of local and/or distant metastases was significantly increased for tumors with more than 1 mitosis and size larger than 5 cm (P<.05). Multivariate analysis in all 69 patients revealed that incomplete resection, age greater than 50 years, non-smooth muscle histological feature, tumor with more than 1 mitosis, and tumor size larger than 5 cm significantly decreased survival. CONCLUSION: Complete gross surgical resection is pre-sently the only means of cure for GIST. Tumors with more than 1 mitosis and a size larger than 5 cm have an especially poor prognosis, with decreased survival, and increased local and/or distant recurrence.
Immunophenotype, proliferation, DNA ploidy, and biological behavior of gastrointestinal stromal tumors: a multivariate clinicopathologic study.
AU: Rudolph,-P; Gloeckner,-K; Parwaresch,-R; Harms,-D; Schmidt,-D
AD: Department of General Pathology, University of Kiel, Germany.
SO: Hum-Pathol. 1998 Aug; 29(8): 791-800
*LHM: Volltext ab 32 (2001) -> siehe Homepage der Bibliothek
Mitte : Pathologie : 22 (1991) -
Sign: Z 13 /062
IS: 0046-8177
PY: 1998
LA: English
CP: UNITED-STATES
AB: To determine the prognostic impact of clinical, immunohistochemical, and biological para-meters, we examined 52 gastrointestinal stromal tumors (GIST) by conventional light microscopy and immunohistochemistry. DNA ploidy was analyzed by image cytometry on cytospin prepara-tion. The proliferative activity was determined by mitosis counting and assessment of Ki-67 re-activity by means of monoclonal antibody Ki-S5. A histopathologic grade was assigned to each tumor according to the French Federation 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. Twenty-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 mortality and metastasis risk. DNA ploidy only correlated with overall survival, 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 metastatic spread. We conclude that GIST are primitive me-senchymal tumors 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.
