Journal of Clinical Oncology, Vol 18, Issue 18
(September), 2000: 3211-3220
© 2000 American Society for Clinical Oncology
Soft Tissue Leiomyosarcomas and Malignant Gastrointestinal Stromal Tumors: Differences in Clinical Outcome and Expression of Multidrug Resistance Proteins
By Boudewijn E. C. Plaat,
Harry Hollema,
Willemina M. Molenaar,
Gerben H. Torn Broers,
Justin Pijpe,
Mirjam F. Mastik,
Harald J. Hoekstra,
Eva van den Berg,
Rik J. Scheper,
Winette T. A. van der Graaf
From the Departments of Pathology, Surgical Oncology, and Medical Oncology, University Hospital Groningen, and Department of Medical Genetics, University of Groningen, Groningen; and Department of Pathology, Free University Hospital, Amsterdam, the Netherlands.
Address reprint requests to Boudewijn E.C. Plaat, MD, PhD, Department of Pathology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; email b.e.ch.plaat{at}kno.azg.nl
PURPOSE: Several studies have reported clinical behavior and chemotherapy resistance in leiomyosarcomas, but these studies did not differentiate between soft tissue leiomyosarcomas (LMS) and malignant gastrointestinal stromal tumors (GIST). Multidrug resistance (MDR) has been associated with the expression of P-glycoprotein (P-gp), multidrug resistance protein (MRP1), and lung resistance protein (LRP). The aim of the present study was to compare LMS and GIST with respect to clinical outcome and MDR parameters.
PATIENTS AND METHODS: Clinical outcome was evaluated in 29 patients with a primary deep-seated LMS and 26 patients with a primary malignant GIST. Paraffin-embedded material, available for 26 patients with LMS and 25 with GIST, was used for immunohistochemical detection of P-gp, MRP1, LRP, and c-kit.
RESULTS: Mean overall survival (OS) was 72 months for LMS patients and 31 months for GIST patients (P < .05). Metastases occurred in 16 (59%) of 27 assessable LMS patients and in 10 (56%) of 18 assessable GIST patients. LMS predominantly metastasized to the lungs (14 of 16 patients), whereas GIST tended to spread to the liver (five of 10 patients) and the abdominal cavity (three of 10 patients; P < .001). P-gp and MRP1 expression was more pronounced in GIST than in LMS (P < .05): the mean percentage of P-gp expressing cells was 13.4% in patients with LMS and 38.4% in patients with GIST, and the mean percentage MRP1 expressing cells was 13.3% in patients with LMS and 35.4% in patients with GIST. LRP expression did not differ between LMS and GIST. c-kit was expressed in 5% of the LMS patients and in 68% of the GIST patients.
CONCLUSION: LMS patients have a better survival than GIST patients, and the metastatic pattern is different. Expression of MDR proteins in LMS is less pronounced than in GIST.
Presented in part at the Thirty-Fifth Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, May 13-18, 1999.
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