Histological Grading in Gastric Cancer by Ming Classification: Correlation with Histopathological Subtypes, Metastasis, and Prognosis

Abstract

The aim of this prospective study was to analyze Ming's classification in correlation with other currently used classification systems of gastric cancer. In addition, we wanted to define the prognostic significance of the Ming classification system. The present study analyzed material of 117 patients with gastric carcinoma who underwent D2-gastrectomy with curative intent. All specimens were categorized according to International Union Against Cancer (UICC) classification, World Health Organization (WHO) classification, Borrmann classification, Laurén classification, Goseki classification, Ming classification, and tumor differentiation. For analysis of correlation between the classification systems, the correlation coefficient according to Spearman was calculated. The survival curves have been calculated according to the Kaplan-Meier method. According to the Ming classification, 38.5% of the carcinomas exhibited an expanding growth pattern, and 61.5% of specimens showed an infiltrating growth pattern. The subtypes according to the Ming and Laurén classification correlated significantly (P < 0.001). WHO classification (P < 0.001), tumor differentiation (P < 0.001), and Goseki classification (P < 0.001), as well as the macroscopic classification of Borrmann (P < 0.001) and the pT and pN categories of the UICC classification exhibited a highly significant correlation with the Ming classification (P < 0.001 and 0.001, respectively). Median overall survival was 31.3 months. In Kaplan-Meier analysis, the 3-year survival rates were lower in the infiltrative tumor type when compared to the expansive tumor type according to Ming (P = 0.0847). In multivariate analysis, only the UICC system presented as an independent prognostic factor in multivariate analysis (P < 0.001). This study shows that the Ming classification correlates significantly with the currently used classification systems for gastric cancer and with the UICC staging system, especially, the pT and pN category. The 3-year survival rates were lower in the infiltrative tumor type than in the expansive tumor type according to Ming. However, the Ming classification is not an independent prognostic factor.

Correlation of Primary Tumor FDG Uptake with Histopathologic Features of Advanced Gastric Cancer

“…None of the studies have reported the degree of FDG uptake according to the Ming classification. As a rationale for low FDG uptake of the diffuse and infiltrative type, it has been postulated that the high number of signet ring cells in the tumors with diffuse type and infiltrative type lead to a reduced FDG concentration in the tumor [4,33]. Another reason could be the lack of expression of the glucose transporter Glut-1 on the cell membrane of most diffuse types of gastric carcinoma [34].…”

“…Appropriate tissue samples were acquired by endoscopic biopsy or surgical resection. Microscopically, the tubular, papillary, mucinous and poorly cohesive types were classified according to the WHO classification, the intestinal type and diffuse type were classified according to the Lauren classification, and the infiltrative type and expanding type were classified according to the Ming classification, as described previously [4,5,25,26]. In the tubular type of adenocarcinoma, the tumors were classified into well, moderately and poorly differentiated types according to the histological differentiation.…”

“…It carries a relatively poor prognosis, with a 5-year survival rate of 30-40 % [2,3]. Adenocarcinoma of the stomach constitutes 90-95 % of all gastric malignancies, and it is subclassified according to the WHO classification, Lauren classification, and Ming and Borrmann classifications [4][5][6][7]. Prognosis of patients with gastric cancer depends on a variety of factors including tumor histology and grade, stage of the disease, presence and extent of lymph node metastasis, and extent of lymph node dissection [1,4].…”

“…Adenocarcinoma of the stomach constitutes 90-95 % of all gastric malignancies, and it is subclassified according to the WHO classification, Lauren classification, and Ming and Borrmann classifications [4][5][6][7]. Prognosis of patients with gastric cancer depends on a variety of factors including tumor histology and grade, stage of the disease, presence and extent of lymph node metastasis, and extent of lymph node dissection [1,4]. With respect to the histopathologic subtypes, it has been shown that the intestinal type according to the Lauren classification, expanding type according to the Ming classification and well-differentiated tumors were associated with a more favorable prognosis in patients with advanced gastric cancer [4,[8][9][10].…”

“…Prognosis of patients with gastric cancer depends on a variety of factors including tumor histology and grade, stage of the disease, presence and extent of lymph node metastasis, and extent of lymph node dissection [1,4]. With respect to the histopathologic subtypes, it has been shown that the intestinal type according to the Lauren classification, expanding type according to the Ming classification and well-differentiated tumors were associated with a more favorable prognosis in patients with advanced gastric cancer [4,[8][9][10]. Also, some studies have reported that patients with the poorly cohesive type according to the WHO classification and Borrmann type IV gastric cancer had a worse prognosis [11][12][13].…”