The prognostic significance of histologic classifications in patients with advanced gastric cancer has been controversial. The purpose of this study was to clarify clinical characteristics according to the Lauren's and Ming's classifications and
to
assess the implication of both classifications as prognostic factor in advanced gastric cancer.
The clinical characteristics according to the histologic classifications were evaluated in 238 patients with advanced gastric cancer who underwent gastrectomy between 1984 and 1993. The authors also investigated whether the Lauren's and Ming's
classification represent a prognostic parameter by log-rank test and Cox proportional hazards models.
Two hundred thirty eight patients were classified as intestinal (114/238, 48%), diffuse(111/238, 47%), and mixed(13/238, 5%), according to Lauren; and as expanding(112/238, 47%) and infiltrative (126/238, 53%), according to Ming.
Carcinomas of intestinal type(n=114) were mostly expanding type (n=101), and carcinomas of diffuse type (n=111) were mostly infiltrative type (n=105). The percentages of diffuse or infiltrative type with young age, Borrmann type Ⅲor Ⅳ, poorly
differentiation, and T3-T4 invasion were significantly greater than those of intestinal or expanding type, respectively, but no significant differences in types of Lauren's or Ming's classifications were found with regard to the tumor size,
regional
lymph node metastasis and distant metastasis. The 5-year survival rate of patients with intestinal type(51.4%) was higher than those of patients with mixed type (45.8%) or diffuse type (30.5%). The 5-year survival rate of patient with expanding
type
(53.9%) was higher than that of patients with infiltrative type (29.6%)
Multivariate analysis by Cox proportional hazards models revealed that primary tumor(T), Borrmann type, Lauren's classification, and regional lymph node(N) were significant prognostic factors.
These results suggest that there are similarities between Lauren's and Ming's classification in regard of age of sex distribution, Borrmann type, tumor, invasion, histologic differentiation, and 5-year survival rate. The combination of WHO
histologic
type with Lauren's and Ming's classifications may provide a fairly complete picture of gastric cancer for prognostic purpose,
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