J Gastric Cancer.  2015 Sep;15(3):183-190. 10.5230/jgc.2015.15.3.183.

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

• Choi JK
• Park YS
• Jung DH
• Son SY
• Ahn SH
• Park DJ
• Kim HH

• KMID: 2372204
• DOI: http://doi.org/10.5230/jgc.2015.15.3.183

Abstract

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.

Keyword

Gastric adenocarcinoma; Lauren classification; Tumor location; Modified Lauren classification; Early gastric cancer

MeSH Terms

Adenocarcinoma
Classification*
Cohort Studies
Gastrectomy
Humans
Multivariate Analysis
Prognosis
Retrospective Studies
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 Five-year overall survival rates of patients with different modified Lauren classification types of gastric cancer. PND = proximal non-diffuse modified Lauren type; D = diffuse modified Lauren type; DND = distal non-diffuse modified Lauren type.

• 

  Fig. 2 Five-year overall survival rates of patients with different modified Lauren classification types of early gastric cancer. PND = proximal non-diffuse modified Lauren type; D = diffuse modified Lauren type; DND = distal non-diffuse modified Lauren type.

Reference

1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006; 24:2137–2150.

2. Moore MA, Eser S, Igisinov N, Igisinov S, Mohagheghi MA, Mousavi-Jarrahi A, et al. Cancer epidemiology and control in North-Western and Central Asia: past, present and future. Asian Pac J Cancer Prev. 2010; 11:Suppl 2. 17–32.

3. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965; 64:31–49.

4. You WC, Blot WJ, Li JY, Chang YS, Jin ML, Kneller R, et al. Precancerous gastric lesions in a population at high risk of stomach cancer. Cancer Res. 1993; 53:1317–1321.

5. Correa P, Haenszel W, Cuello C, Zavala D, Fontham E, Zarama G, et al. Gastric precancerous process in a high risk population: cross-sectional studies. Cancer Res. 1990; 50:4731–4736.

6. Carneiro F, Huntsman DG, Smyrk TC, Owen DA, Seruca R, Pharoah P, et al. Model of the early development of diffuse gastric cancer in E-cadherin mutation carriers and its implications for patient screening. J Pathol. 2004; 203:681–687.

7. Marrelli D, Roviello F, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, et al. Italian Research Group for Gastric Cancer. Different patterns of recurrence in gastric cancer depending on Lauren's histological type: longitudinal study. World J Surg. 2002; 26:1160–1165.

8. Sakaguchi T, Watanabe A, Sawada H, Yamada Y, Tatsumi M, Fujimoto H, et al. Characteristics and clinical outcome of proximal-third gastric cancer. J Am Coll Surg. 1998; 187:352–357.

9. Shah MA, Khanin R, Tang L, Janjigian YY, Klimstra DS, Gerdes H, et al. Molecular classification of gastric cancer: a new paradigm. Clin Cancer Res. 2011; 17:2693–2701.

10. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.

11. Muñoz N, Correa P, Cuello C, Duque E. Histologic types of gastric carcinoma in high- and low-risk areas. Int J Cancer. 1968; 3:809–818.

12. Stalsberg H. Histological typing of gastric carcinoma. A comparison of surgical and autopsy materials, and of primary tumours and metastases. Acta Pathol Microbiol Scand A. 1972; 80:509–514.

13. Kim KH, Chi CH, Lee SK, Lee D, Kubo T. Histologic types of gastric carcinoma among Koreans. Cancer. 1972; 29:1261–1263.

14. Stemmermann GN, Brown C. A survival study of intestinal and diffuse types of gastric carcinoma. Cancer. 1974; 33:1190–1195.

15. Correa P, Cuello C, Duque E. Carcinoma and intestinal metaplasia of the stomach in Colombian migrants. J Natl Cancer Inst. 1970; 44:297–306.

16. Qiu MZ, Cai MY, Zhang DS, Wang ZQ, Wang DS, Li YH, et al. Clinicopathological characteristics and prognostic analysis of Lauren classification in gastric adenocarcinoma in China. J Transl Med. 2013; 11:58.

17. Dittmar Y, Rauchfuss F, Dondorf F, Ardelt M, Scheuerlein H, Settmacher U. Extended pathohistological criteria for assessment of the long-term prognosis of gastric cancer. Zentralbl Chir. 2015; DOI: 10.1055/s-0034-1383080. [In print].

18. Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Ueno M, et al. Prognostic factors in adenocarcinoma of the gastric cardia: pathologic stage analysis and multivariate regression analysis. J Clin Oncol. 1997; 15:2015–2021.

19. Hansson LE, Sparén P, Nyrén O. Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985. Br J Surg. 1993; 80:374–377.

20. Ohno S, Tomisaki S, Oiwa H, Sakaguchi Y, Ichiyoshi Y, Maehara Y, et al. Clinicopathologic characteristics and outcome of adenocarcinoma of the human gastric cardia in comparison with carcinoma of other regions of the stomach. J Am Coll Surg. 1995; 180:577–582.

21. Shah MA, Kelsen DP. Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease. J Natl Compr Canc Netw. 2010; 8:437–447.

22. Kim JW, Hwang I, Kim MJ, Jang SJ. Clinicopathological characteristics and predictive markers of early gastric cancer with recurrence. J Korean Med Sci. 2009; 24:1158–1164.

23. Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011; 11:69–77.

24. Park JM, Kim YH. Current approaches to gastric cancer in Korea. Gastrointest Cancer Res. 2008; 2:137–144.