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Introduction: Many risk scores for malignancy in gastrointestinal stromal tumors (GISTs) are based on the combination of size, mitotic index, and location in order to predict recurrence, appearance of metastases, or survival., Design: This is a prospective analysis of prognosis factors (size, mitotic index, Ki-67, and others) and malignancy risk scores (Fletcher's, modified NIH, Miettinen, NCCN, and A or B Goh's scores). This is a study of the sensitivity and specificity of the different malignancy risk scores in the prognosis of recurrence and survival., Materials and Methods: We operated on 52 patients from 1 January 2002 to 10 January 2008. Mean follow-up was 35 months. We used SPSS 13.0 for Windows for the statistical analysis. The differences between frequencies and means were calculated using the chi-square test, Student's t test, and analysis of variance. Kaplan-Meier and the Cox multiple regression methods were used to calculate overall and disease-free survival. Sensitivity and specificity were depicted graphically as receiver operating characteristic (ROC) curves., Results: Thirteen patients suffered recurrences (27.7%). Eleven died from disease-related causes. Two-year and 5-year actuarial survival was 80% and 76%, respectively, and the mean survival was 60 months (CI 95% 51.9-69.5). Two-year and 5-year actuarial disease-free survival was 76% and 72% respectively, and the mean disease-free survival was 52 months (CI 95% 43.5-61.1). The score proposed by Fletcher has the greatest sensitivity and specificity in our series to predict overall survival (AUROC = 0.761; SE 0.084, p = 0.009; CI 95% 0.597-0.926) and recurrence (AUROC RECURRENCE = 0.693; SE 0.087, p = 0.042; CI 95% 0.523-0.864) compared with other scores.

Objective: To analyze the different factors predictive of survival associated with optimal R0-cytoreduction in c-kit-positive gastrointestinal stromal tumors., Methods: Thirty-five patients were operated on in our Oncological Surgery Department from January 2002 to February 2007 because of CD117/c-kit-positive gastrointestinal stromal tumors, and an optimal surgical cytoreduction was obtained without macroscopical residual disease. Demographic, anatomical, clinical, pathological, and immunohistochemical variables were analyzed from a specific database. Survival and multivariate analyses were developed using Kaplan-Meier and multiple Cox regression models, respectively., Results: Five-year overall survival was 77% with a mean survival of 52 months. Risk of malignant behaviour according to Fletcher s classification and tumor size higher than 10 cm had a significantly negative influence on overall survival in the univariate analysis (p < 0.05). Proliferative Ki-67 activity higher than 50% was the only statistically significant variable in the multivariate analysis. Twenty percent of tumors recurred. Only 3 patients with metastatic disease received adjuvant treatment with imatinib mesylate, all of them with Ki-67 > 50% and currently alive., Conclusions: The poliferative Ki-67 index could represent an excellent predictive factor for survival in patients with c-kit-positive stromal gastrointestinal tumors. Confirmation and an adequate cut-off level should be the main objectives for future prospective studies, mostly focused on the appropriate selection of optimal candidates to imatinib-mesylate-based treatment.

Introduction: Carney's triad is a rare pathogenic entity which consists of the association in young women of multiple condromatosis in the lung, gastric leiomyosarcoma, and extradrenal paraganglioma; although the presence of three at the same time is not required for its diagnosis., Case Report: We present the case of a 27-year-old woman who was diagnosed of pulmonary multiple hamartomatosis and gastric stromal tumor., Discussion: A review of the literature shows the most important prognosis factors and therapeutic options. Surgery for gastrointestinal stromal tumors and extradrenal paraganglioma seems to be the best treatment up to date.