A population-based study on incidence rates, Lauren distribution, stage distribution, treatment, and long-term outcomes for gastric adenocarcinoma in Central Norway 2001–2011

Bringeland, Erling Audun; Wasmuth, Hans H.; Mjønes, Patricia; Myklebust, Tor Åge; Grönbech, Jon Erik

doi:10.1080/0284186x.2016.1227086

Cited by 24 publications

(29 citation statements)

References 22 publications

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“…The Lauren classification divided GC into intestinal and diffuse subtypes (10). Intestinal-type GC occurs more frequently in elderly male patients and is thought to be associated with improved survival (11,12). In 2010, the World Health Organization (WHO) re-classified gastric adenocarcinoma into five major subtypes: tubular, papillary, mucinous, poorly cohesive, and mixed.…”

Section: Introductionmentioning

confidence: 99%

Does histology really influence gastric cancer prognosis?

Luu¹,

Thapa²,

Woo³

et al. 2017

J. Gastrointest. Oncol.

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Background: Gastric cancer (GC) is associated with poor survival despite curative-intent surgical resection and systemic therapy. Our objective is to examine the impact of histology on prognosis as well as the impact of linitis plastica (LP) on survival. Methods:The GC database at a single institution was evaluated for patients who underwent resection from 2000 to 2015. Clinicopathologic characteristics were examined and descriptive statistics was used to analyze four groups of patients based on Lauren classification: intestinal (n=93), diffuse (n=20), diffuse with signetring cell features (n=57), and LP (n=40). LP patients had diffuse GC but also presented with circumferential infiltration of the gastric wall for at least a third of the stomach length on endoscopy or imaging. Fisher's exact test was used to compare groups; Cox regression was used for multivariate analysis and Kaplan-Meier method for survival. Results: Of 210 patients who underwent gastric resection, 112 (53%) were male with mean age 65.3 years (SD ±14.6 years). Intestinal GC patients were older at diagnosis but other patient demographics were similar between all groups. LP patients had a higher rate of R1 resection despite higher rates of total gastrectomy (P<0.01). Rates of perineural invasion (PNI) and nodal metastasis were higher in LP (P<0.001). The majority of intestinal GC patients (79%) had stage I/II disease compared to 70% of LP patients with stage III disease.Median overall survival (OS) was 13.7 months for LP, 79 months for intestinal, 97 months for signetring cell, and not reached for diffuse GC (P<0.001). When stratified by stage, there were no significant differences in survival by histology for stage II and stage III patients. However, by Cox regression analysis, factors associated with worse survival included lymphovascular invasion (LVI), nodal disease, and presence of LP. Neutrophil-lymphocyte ratio (NLR), neoadjuvant and adjuvant therapy, and tumor regression grade did not influence survival on multivariate analysis. Conclusions:Intestinal GC is thought to have a better prognosis. Interestingly, this study demonstrates similar outcomes in patients with intestinal, diffuse, and signet-ring cell GC. However, a subset of diffuse GC-LP was associated with an infiltrative pattern of disease characterized by PNI and LVI. Despite controlling for poor prognostic markers, LP was independently associated with a worse prognosis. More research is needed to identify methods of earlier diagnosis and effective systemic therapy to treat this aggressive disease.

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Section: Introductionmentioning

confidence: 99%

Does histology really influence gastric cancer prognosis?

Luu¹,

Thapa²,

Woo³

et al. 2017

J. Gastrointest. Oncol.

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“…Metastatic gastric cancer has a notorious reputation for its high prevalence at initial diagnosis and poor prognosis even with the advent of palliative systemic chemotherapy . Advancements in the management of metastatic intraabdominal malignancies seeking not just to palliate but to push boundaries on achieving significant improvements in overall survival have been contingent upon the identification of subgroups of each metastatic malignancy who may best benefit from targeted, multimodality therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Gastric cancer continues to be a significant contributor to cancer‐related mortality across the world, accounting for 723,000 deaths per year, the third most frequent cause of cancer‐related deaths . There is a high prevalence of advanced disease at presentation, with up to 39–44% of newly diagnosed gastric cancer cases harboring disseminated disease at initial diagnosis . It has been well established that untreated metastatic gastric cancer carries a poor prognosis with a median overall survival of 4 months and 5‐year survival rates of 3–6% .…”

Section: Introductionmentioning

confidence: 99%

Metastatic gastric cancer: Does the site of metastasis make a difference?

Tan

Chia

Tan

et al. 2018

Asia-Pac J Clncl Oncology

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“…According to Lauren’s classification, GC is divided into two histological entities characterized by different epidemiology, pathogenesis, biological features and clinical behavior: the intestinal and diffuse subtypes [ 17 ]. Intestinal-type tumors form gland-like structures; are strongly associated with severe atrophic gastritis, intestinal metaplasia and Helicobacter Pylori infection; and display a better survival [ 18 , 19 , 20 ]. On the other hand, diffuse histology is associated with cellular discohesion (due to the lack of cadherin E expression) and poor differentiation and is characterized by chemoresistance, rapid progression and poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

Zurlo

Basso

Strippoli

et al. 2020

Cancers

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Background: Guidelines recommend a perioperative approach in patients with stage II/III gastric cancer, but in real-life many patients receive immediate surgery followed by adjuvant chemotherapy (aCT). Although histologic subtypes may have different response to CT, no study has explored the influence of histotype on the efficacy of perioperative CT (pCT) or aCT. Materials and methods: The objective of the study was to evaluate the impact of clinicopathological features and histology (intestinal or diffuse) on survival according to strategy (pCT vs. aCT). The primary endpoint was overall survival (OS) and the secondary endpoint was event-free survival (EFS). Results: Out of 203 patients affected by LAGC, 83 received pCT and 120 aCT. At multivariate, histology and LVI in pCT cohort and positive resection margin in the aCT influenced both OS and EFS. No difference in EFS and OS was observed in relation to strategy. However, in the intestinal-type of pCT cohort survival outcomes were significantly higher compared to the aCT cohort, whereas in the diffuse-type were significantly worse in patients receiving pCT compared to those receiving aCT. Conclusions: Although retrospective and small-sized, this study suggests that the benefit of pCT might be limited to the intestinal-type. This hypothesis needs to be confirmed in prospective series.

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A population-based study on incidence rates, Lauren distribution, stage distribution, treatment, and long-term outcomes for gastric adenocarcinoma in Central Norway 2001–2011

Cited by 24 publications

References 22 publications

Does histology really influence gastric cancer prognosis?

Does histology really influence gastric cancer prognosis?

Metastatic gastric cancer: Does the site of metastasis make a difference?

Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

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