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

Abstract

BackgroundAccording 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.MethodsWe 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.ResultsThere 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).ConclusionsDiffuse 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.

DNA hypermethylation of the vimentin gene inversely correlates with vimentin expression in intestinal- and diffuse-type gastric cancer

“…The difference in tumor extension between intestinal and diffuse-type carcinoma is of clinical significance in the selection of a suitable treatment strategy (14,15). In the present study, the younger age (P=0.023), higher T (P=0.020), N (P=0.032) and TNM stage (P=0.039) of patients with diffuse-type GC indicated that diffuse-type was more invasive than intestinal-type GC, which may contribute to the poorer prognosis of patients with diffuse-type carcinoma (30). An improved understanding of the underlying pathogenesis and molecular events of the two histological subtypes may facilitate the development of novel diagnostic, therapeutic and preventive strategies for GC.…”

Faraldsfræði tveggja Laurén-flokka kirtilfrumukrabbameina í maga á Íslandi árin 1990-2009

“…4,10,14,19 Rannsóknir eru þó ekki allar alveg samhljóma og hafa sumar sýnt fram á faekkun í báðum hópunum. 20,21 Líkt og aðrir hafa sýnt fram á, þar með talið Laurén sjálfur, voru þeir sem greindust með dreifkrabbamein í okkar rannsókn yngri 10,22,23 og kynjahlutfallið í hópi dreifkrabbameina jafnara. 22,23 Fyrri rannsóknir hafa þegar sýnt verri lifun sjúklinga með dreifkrabbamein en þó ekki allar eftir að leiðrétt hefur verið fyrir öðrum samverkandi þáttum.…”

“…20,21 Líkt og aðrir hafa sýnt fram á, þar með talið Laurén sjálfur, voru þeir sem greindust með dreifkrabbamein í okkar rannsókn yngri 10,22,23 og kynjahlutfallið í hópi dreifkrabbameina jafnara. 22,23 Fyrri rannsóknir hafa þegar sýnt verri lifun sjúklinga með dreifkrabbamein en þó ekki allar eftir að leiðrétt hefur verið fyrir öðrum samverkandi þáttum. 24,25 Rannsókn okkar leiddi hins vegar í ljós marktaekan mun á lifun útfrá Laurén-flokkun eftir leiðréttingu fyrir ýmsum samverkandi þáttum, þar með talið stigi og niður-stöðu aðgerðar.…”

“…Rannsóknin er því samhljóma nýlegum rannsókn-um sem benda til þess að það að greinast með dreifkrabbamein samkvaemt Laurén-flokkun sé sjálfstaeður áhaettuþáttur fyrir verri horfum. 22,23,26 Talsverður hluti af meinunum var ekki stiganlegur, eða 25%, annaðhvort vegna þess að sjúkraskrárnar fundust ekki eða upplýsingarnar í sjúkraskránum voru ekki fullnaegjandi. Stigun byggir á myndgreiningu með tilliti til fjarmeinvarpa og lýsingu meinafraeðings í vefjasvörum brottnumins maga sem lýsir dýpt aexlis og því hvort meinvörp séu til staðar í eitlum.…”

Goseki Grade and Tumour Location Influence Survival of Patients with Gastric Cancer

“…Histologically, GCs are highly heterogeneous tumours in terms of structural or cytological features. Throughout the last fifty years, the histologic classification of GC has continued mostly with reference to Lauren design, in which diffuse and intestinal carcinoma are the two main histologic sub-groups in addition to uncommon variants such as 'indeterminate type' (Hu et al, 2012;Fontana et al, 2003;Qiu et al, 2013).…”