Histologic types of gastric carcinoma among Koreans

Superiority of Tumor Location-Modified Lauren Classification System for Gastric Cancer: A Multi-Institutional Validation Analysis

Background

The tumor location-modified Lauren classification (mLC) has been proposed recently, but its clinical significance remains under debate. This study aimed to elucidate the clinical relevance of mLC and evaluate its superiority to the Lauren classification (LC) for gastric cancer patients with gastrectomy.

Methods

This study retrospectively evaluated 2764 consecutive gastric cancer patients from three comprehensive medical institutions. The patients were categorized into training, inner-validation, and independent validation sets. The relationships between mLC and other clinicopathologic factors were analyzed, and independent prognostic factors were identified. Survival prognostic discriminatory ability and predictive accuracy were compared between mLC and LC using the concordance index (C-index) and Akaike’s information criterion (AIC), and a nomogram based on mLC was constructed to compare its prognostic improvement with the tumor-node metastasis (TNM) staging system.

Results

A significant association between mLC and gender, age, histologic type, T stage, N stage, and M stage was found. The findings showed that mLC, not LC, is an independent prognostic factor, with a smaller AIC and a higher C-index than LC. The nomogram based on mLC showed a better predictive ability than TNM alone.

Conclusions

Compared with LC, mLC, which could be considered a more reliable prognostic factor, may improve the prognostic discriminatory ability and predictive accuracy for gastric cancer patients with gastrectomy.

Electronic supplementary material

The online version of this article (10.1245/s10434-018-6654-8) contains supplementary material, which is available to authorized users.

Correlation between Histopathology and Natural History of Intestinal-Type Adenocarcinoma and Diffuse Undifferentiated Carcinoma of the Stomach

A total of 400 cases of surgically removed carcinoma of the stomach between 1955 and 1967 were reclassified histologically in two basic types: the adenocarcinoma of intestinal type and the diffuse undifferentiated carcinoma. The identification of both types was possible in all cases, which were then divided thus: 296 (74%) of the intestinal and 104 (26%) of the diffuse type with a ratio of 2.85:1. The papillary, medullary, scirrhous and colloid variants of the intestinal type represented together 31.4% of these cases; the micro-glandular and the colloid variants of the diffuse carcinoma represented 53.8%. In the 127 regional cases (42.9%) of the intestinal type all the lymph node metastases had the same histological structure as the primary whereas in the 43 regional cases (41.3%) of the diffuse type the structure was of the intestinal type in 4 cases (9.3%). Atrophic gastritis and intestinal metaplasia were found in the gastric mucosa adjacent to the tumor in 91.9% of the males and in 91.2% of the females with the intestinal type; corresponding figures for the diffuse carcinoma are 21.6% and 45.9% (p < 0.000000001). Of 296 cases of the intestinal type 194 were males and 102 females with a ratio M/F = 1.90; the ratio for 61 males and 43 females with diffuse carcinoma was 1.41. There was no evidence of a statistical relationship between sex and histological type of tumor. Mean age for males with the intestinal type was 59.0 yrs, with diffuse carcinoma 55.9 (p < 0.05); for females with the intestinal type was 60.6 yrs, and with diffuse carcinoma 55.3 (p < 0.001). The age-group with the highest predominance of diffuse carcinoma was below 55 years (54.8% of the cases). In females below 55 yrs of age the diffuse type was more frequent than the intestinal type. In the three age groups considered (≤ 55, 56–65, ≥ 65 years) the diffuse carcinoma showed the same distribution in both sexes, whereas the intestinal type revealed less uniformity. Survival rates after 5 years followup of 221 patients with localized disease calculated by means of the life table method were 50% for the intestinal type and 42% for the diffuse carcinoma. Median survival time was 4 years and 9 months for the former and 3 years and 6 months for the latter. Adequate information on 264 cases demonstrated that 70% lived in the Province of Milan; the ratio of intestinal type carcinomas to diffuse carcinomas was 3.33 in Brianza (provincial area north of Milan) and 2.05 in the city of Milan. No relevant association was found between blood group and histologic type of carcinoma. From 1955 to 1967 the ratio between the intestinal and the diffuse type in the patients operated in this Institute seemed to indicated a slightly increasing trend.

Clinical-statistical Correlation in 286 Cases of Diffuse and Intestinal Carcinoma of the Stomach

286 gastric carcinoma cases have been classified according to Lauren's system. The intestinal and diffuse histotypes are compared, and correlated with the epidemiologic data, type of operation and follow-up. The results show that total gastrectomy is indicated in diffuse carcinoma.

Clinical Relevance of the Tumor Location-Modified Lauren Classification System of Gastric Cancer

Purpose

The Lauren classification system is a very commonly used pathological classification system of gastric adenocarcinoma. A recent study proposed that the Lauren classification should be modified to include the anatomical location of the tumor. The resulting three types were found to differ significantly in terms of genomic expression profiles. This retrospective cohort study aimed to evaluate the clinical significance of the modified Lauren classification (MLC).

Materials and Methods

A total of 677 consecutive patients who underwent curative gastrectomy from January 2005 to December 2007 for histologically confirmed gastric cancer were included. The patients were divided according to the MLC into proximal non-diffuse (PND), diffuse (D), and distal non-diffuse (DND) type. The groups were compared in terms of clinical features and overall survival. Multivariate analysis served to assess the association between MLC and prognosis.

Results

Of the 677 patients, 48, 358, and 271 had PND, D, and DND, respectively. Their 5-year overall survival rates were 77.1%, 77.7%, and 90.4%. Compared to D and PND, DND was associated with significantly better overall survival (both P<0.01). Multivariate analysis showed that age, differentiation, lympho-vascular invasion, T and N stage, but not MLC, were independent prognostic factors for overall survival. Multivariate analysis of early gastric cancer patients showed that MLC was an independent prognostic factor for overall survival (odds ratio, 5.946; 95% confidence intervals, 1.524~23.197; P=0.010).

Conclusions

MLC is prognostic for survival in patients with gastric adenocarcinoma, in early gastric cancer. DND was associated with an improved prognosis compared to PND or D.

Clinicopathological characteristics and prognostic analysis of Lauren classification in gastric adenocarcinoma in China

Background

According to the Lauren classification, gastric adenocarcinomas are divided into diffuse and intestinal types. The causative attribution explaining the dismal prognosis of diffuse-type remains unknown.

Methods

We examined the archive of 1000 patients with gastric adenocarcinomas who received radical gastrectomy in our center and assessed the effect of the Lauren classification on survival in a multivariate approach. Moreover we compared the variation of clinical features between the diffuse-type and intestinal-type and explored the contributing factors for the prognostic difference.

Results

There were 805 resectable patients for the final analysis. Diffuse-type comprised of 48.7% in the gastric carcinoma in our group and showed poorer prognosis than intestinal-type (P=0.013). Multivariate analysis revealed that independent prognostic factors for gastric carcinoma patients were T stage (P<0.001), N stage (P<0.001) tumor size (P<0.001) and Lauren classification (P=0.003). For the clinical features, diffuse-type was significantly associated with younger age (p<0.001), female preponderance (p <0.001), distal location (P<0.001), advanced pT (p < 0.001), advanced pN (p < 0.001) and advanced TNM stage (p = 0.027).

Conclusions

Diffuse type adenocarcinoma carries a worse prognosis that may be partially explained by the tendency of this subtype to present at more advanced T and N stage. However, Lauren classification has prognostic significance that is independent of T and N stage as well as other prognostic variables based on the multivariate cox analysis.

High rates of advanced gastric cancer in community of Flushing, New York

BACKGROUND

Gastric cancer remains a major public health issue and is a leading cause of death worldwide, accounting for 600,000 deaths annually. Over the last decades, there has been a steady decline in the incidence rates of gastric cancer. Furthermore, the incidence rates of gastric cancer in different parts of the country vary due to epidemiological and migration trends. Despite these trends, several studies that have continued to observe high rates of gastric cancer in populations that come from high-risk regions.

AIM OF THE STUDY

The aim of the study was to describe the gastric cancer patients presenting NYHQ with an emphasis on those presenting at a young age and advanced disease. A subanalysis of the Asian population was also done, which is considered a high-risk group.

METHODS

Consecutive chart review of patients admitted with gastric cancer from January 2000 to August 2008 was extracted from the Oncology registry at NYHQ. Parameters that were evaluated were age, sex, race, type of gastric cancer, and stage of gastric cancer at initial presentation. The SAS/PC software package (SAS Institute Inc., Cary, NC) was employed for statistical analyses.

RESULTS

Four hundred fifty-seven patients were diagnosed with gastric cancer. Approximately one third of the total patients were younger than 60 years of age. Of the Asian patients, almost half the patients (48.8%) had advanced disease of which two thirds were under the age of 60 years.

CONCLUSION

The rates of advanced gastric cancer observed at NYHQ are significant and comparable to recent epidemiology literature on rates in Asian populations in Asia. Communities, like Flushing, NY, may benefit from early detection of gastric cancers, similar to those instituted in Japan and Taiwan.

Gastric cancer in young patients

A retrospective review of the Roswell Park Memorial Institute experience and literature review of gastric carcinoma in young adults reveals that long-term survival is rarely achieved. The primary correctable cause of failure is a very long delay in diagnosis, a result of both reluctance to initiate diagnostic studies and inaccuracy of routine upper gastrointestinal series. A high index of suspicion and liberal utilization of gastroscopy and gastric cytology combined with an aggressive surgical approach to gastric pathology would probably lead to improved survival for the young gastric carcinoma patients.

Host response and tumour biological behaviour in the two histological types of gastric carcinoma

It appears that there is validity in categorizing gastric carcinoma into two histologic types, intestinal and diffuse. The local host tissue response in 92.5% of cases of the intestinal type of gastric carcinoma was of an exudative nature. Diffuse gastric carcinoma in 70% of cases incited a dense productive fibrosis. Pools of mucin and large number of 'signet-ring' cells were mostly encountered in the intestinal type of carcinoma. Applying Dukes' parameters the tumour was found to be more than three times more invasive in cases of diffuse carcinoma. The prognostic bearing of the two histologic types, different host tissue response, behaviour of the tumour in terms of mucous production and local extension are discussed and it is suggested that diffuse gastric carcinoma carries a worse prognosis than the intestinal type. Study of a larger series of cases and longer follow-up with controlled treatment is essential to confirm this assessment.

Stomach carcinoma among Hawaiians and Caucasians in Hawaii

A review of Caucasian and Hawaiian patients with stomach carcinoma in Honolulu reinforces observations in other racial groups that the Lauren diffuse histopathological type of gastric cancer is more frequent in females and younger patients, while the so-called intestinal type is more common in older patients and men; that the intestinal form has a better prognosis; and that there are more long-term survivors among women than men with diffuse carcinoma. Prognosis and the level of cancer risk are not associated in Hawaii, since Hawaiians share high risk with Japanese and poor prognosis with Caucasians. There is no apparent association of cancer risk with the ratio of intestinal to diffuse forms among Hawaiians, Caucasians, and Japanese. In addition to the known high risk of stomach carcinoma in Hawaiians and Japanese, this study has identified a high risk among people of Portuguese ancestry.