Women proved to have a more favorable overall outcome than men in the series. Sex has not been found to be of significance in population-based studies from Sweden and Iceland (Nilsson et al. 2005; Tryggvason et al. 2005), but in a study selleck by DeMatteo et al. (2000), male sex was a poor prognostic sign. The mean age at the time of diagnosis was almost equal between the sexes, and reasons other than age for longer survival among the women in our study must be considered. The location of the primary tumor has been found to be of importance by others (Emory et al. 1999; Nilsson et al. 2005) and is again confirmed in this study. Patients with gastric GISTs lived longer than patients with small bowel tumors. Nuclear atypia, either focal or diffuse, was found in this series to be an unfavorable morphologic variable, which has previously been reported by some (Miettinen et al.
2005) but not by others (Iesalnieks et al. 2005). In this study, we tested nuclear morphometric characteristics as potential independent variables for evaluating risk of malignancy in a large series of GISTs. In univariate models, some of these factors show a prognostic value for survival, but the significance is lost in multivariate models because of the strong correlation with mitoses and tumor size. Nuclei with less round features and with a lower SL ratio correspond to spindle cells, and those with rounder nuclei and higher SL ratios correspond to epithelioid cells. Investigation of predominant cell type, spindled or epithelioid, in GISTs has been evaluated in our study and also by others, without showing significance for overall survival (Carrillo et al.
1997; Iesalnieks et al. 2005; Miettinen et al. 2005). Nuclear roundness and nuclear ratio are interesting independent variables but should probably not be considered important as prognostic variables at this stage. Anatomical site of the primary tumor is now being accepted as a variable to be considered in risk stratification of primary GISTs (Hornick and Fletcher 2007). We suggest, however, that sex and nuclear atypia should also be considered when risk of malignancy in GISTs is evaluated. Further study of variables, which may provide information beyond that, gleaned from number of mitoses, tumor size, and site, is required in the prognostication of GISTs. Acknowledgments T.O.N. is a Scholar of the Michael Smith Foundation for Health Research.
The tissue microarray facility at the Genetic Pathology Evaluation Centre is supported in part by an unrestricted educational grant Dacomitinib from sanofi-aventis.
Objective To examine the risk of neurological and autoimmune disorders of special interest in people vaccinated against pandemic influenza A (H1N1) with Pandemrix (GlaxoSmithKline, Middlesex, UK) compared with unvaccinated people over 8-10 months.