Clinicopathological Predictors of High Mitotic Rate in Gastrointestinal Stromal Tumors: A Cross-Sectional Study in Iraq

Authors
  • Noha Salman

    Department of Medical Oncology, Al-Jawad Center, Baghdad, Iraq.

  • Rabah Haeab

  • Hawraa R. Salih

    Medical City Complex, Baghdad Teaching Hospital, Baghdad, Iraq.

Keywords:
Gastrointestinal Stromal Tumor, Mitotic Rate, Epithelioid Subtype, Tumor Size, Iraq, Prognostic Factors
Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract and exhibit heterogeneous biological behavior. Prognostic determinants—particularly tumor size, mitotic rate, and histopathological subtype—guide treatment decisions and surveillance intensity. This study aimed to characterize the clinicopathological features of Iraqi patients with GIST and identify factors associated with a high mitotic rate. We conducted a cross-sectional study of 50 consecutive adults with histopathologically confirmed GIST managed between April 2022 and February 2023 at the Oncology Teaching Hospital and Hematology Department, Medical City Complex, Baghdad, Iraq. Extracted variables included demographics, clinical presentation, tumor site, size, stage, metastasis, histology, and immunohistochemical markers (CD117, DOG-1, CD34, actin). Eligible patients were adults (≥18 years) with histopathologically confirmed GIST and sufficient clinicopathological data. Descriptive statistics summarized cohort characteristics. Associations with a high mitotic rate were assessed using chi-square or Fisher’s exact tests, followed by multivariable logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI). The mean age was 58.7 ± 9.2 years; 56% were female. Hematemesis was the most frequent presentation (42%). The stomach was the most common primary site (36%). Metastasis was present in 58% of patients, most commonly hepatic. High mitotic rate occurred in 40% of cases and was significantly associated with age <60 years, stomach location, tumor size >5 cm, advanced stage, epithelioid histology, and metastasis. In multivariable analysis, tumor size >5 cm (OR 7.0; 95% CI 2.1–23.3), epithelioid subtype (OR 6.5; 95% CI 1.7–24.8), and advanced stage (OR 4.3; 95% CI 1.2–15.2) independently predicted a high mitotic rate. In this Iraqi cohort, larger tumor size, epithelioid morphology, and advanced stage were independently associated with high mitotic activity. These findings underscore the need for earlier detection and context-appropriate risk stratification to improve outcomes.

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Published
2026-05-08
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Research Article/Original Research
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Copyright (c) 2026 Noha Salman, Rabah Haeab, Hawraa R. Salih

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How to Cite

Salman, N., Haeab, R., & Salih, H. R. (2026). Clinicopathological Predictors of High Mitotic Rate in Gastrointestinal Stromal Tumors: A Cross-Sectional Study in Iraq. Middle Eastern Cancer and Oncology Journal, 2(2), 26-32. https://doi.org/10.61706/

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