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  Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 45-47
 

Is histologic differentiation a prognostic indicator for gastric carcinoma patients with curative resection?


1 Department of Surgery, Division of Gastroenterologic Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju, 501-757, Korea
2 Department of Pathology, Division of Gastroenterologic Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju, 501-757, Korea

Date of Web Publication3-Feb-2016

Correspondence Address:
D Y Kim
Department of Surgery, Division of Gastroenterologic Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju, 501-757
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175569

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 » Abstract 

Background: The prognostic relevance of histologic differentiation in gastric carcinoma patients with curative resection is unclear. We analyzed the clinicopathologic features of gastric carcinoma patients with curative resection according to the histologic differentiation and evaluated surgical outcome. Materials And Methods: Of 1198 gastric carcinoma patients with curative resection (American joint committee on cancer, Stages I-III), 274 (22.9%) had well-differentiated, 331 (27.6%) had moderately differentiated and 593 (49.5%) had poorly differentiated gastric carcinomas. Results: Patients with the poorly differentiated type had more prominent serosal invasion, much more lymph node involvement and more advanced stage than patients with the well-differentiated type. The overall survival rate was higher for patients with a well-differentiated gastric carcinoma than for patients with a poorly differentiated type. Using Cox's proportional hazard regression model, histologic differentiation was found to be a statistically significant prognostic parameter (risk ratio, 1.41; 95% confidence interval, 1.028-1.922; P < 0.05). Conclusion: Our results suggest that patients with a well-differentiated gastric carcinoma have a good prognosis compared with those with a poorly differentiated type. Therefore, histologic differentiation can be used as a prognostic indicator in gastric carcinoma patients with curative resection.


Keywords: Curative, gastric carcinoma, histologic differentiation, prognostic indicator


How to cite this article:
Ryu S Y, Kim H G, Joo J K, Kang H, Lee J H, Kim D Y. Is histologic differentiation a prognostic indicator for gastric carcinoma patients with curative resection?. Indian J Cancer 2015;52:45-7

How to cite this URL:
Ryu S Y, Kim H G, Joo J K, Kang H, Lee J H, Kim D Y. Is histologic differentiation a prognostic indicator for gastric carcinoma patients with curative resection?. Indian J Cancer [serial online] 2015 [cited 2021 Dec 7];52:45-7. Available from: https://www.indianjcancer.com/text.asp?2015/52/1/45/175569



 » Introduction Top


Gastric carcinoma can be divided into two major histologic categories: The so-called intestinal, expanding or differentiated type and the diffuse, infiltrative or undifferentiated type.[1],[2] The former includes well-differentiated adenocarcinoma, which is characterized by a distinct pattern of glands comprising columnar epithelium separated by a moderate or a small amount of stroma. Most of the latter tumors are poorly differentiated adenocarcinoma, signet-ring cell carcinoma or mucinous adenocarcinoma. Whether histologic differentiation is a prognostic indicator for gastric carcinoma patients with curative resection is controversial. We analyzed the clinicopathologic features of gastric carcinoma patients with curative resection according to the histologic differentiation.


 » Materials and Methods Top


Patients and specimens

From 1995 to 2005, 1198 patients with gastric carcinoma American Joint Committee on Cancer (AJCC, Stages I-III) were treated curatively. Of these, 274 (22.9%) were well-differentiated, 331 (27.6%) were moderately differentiated and 593 (49.5%) were poorly differentiated gastric carcinomas.

Information on the patient's age, gender, tumor size, tumor location, depth of invasion, level of lymph node invasion and stage at initial diagnosis was obtained from the hospital records. The (AJCC) TNM) staging system was used for pathologic staging,[3] histological evaluation was performed according to the Japanese General Rules for Gastric Cancer Study in Surgery and Pathology.[4]

Statistical analysis

The data were analyzed statistically using the Chi-square test. The overall survival rates were calculated using the Kaplan-Meier method and the differences between the curves were tested using the log-rank test. A P < 0.05 was considered to be statistically significant.


 » Results Top


[Table 1] summarizes the clinicopathologic findings of 274 (22.9%) well-differentiated, 331 (27.6%) moderately differentiated and 593 (49.5%) poorly differentiated gastric carcinomas in patients with curative resection.
Table 1: Clinicopathologic features of gastric carcinoma patients with well, moderately and poorly differentiated groups

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Patients with a well-differentiated gastric carcinoma were characterized by old age (59.6 vs. 55.2 years; P < 0.001) and being male (73.4 vs. 58.3%; P < 0.001) compared to those patients with a poorly differentiated type. The mean tumor size in the well-differentiated gastric carcinoma group was significantly smaller than that in the poorly differentiated type group (3.4 vs. 4.2 cm; P < 0.001). Well-differentiated gastric carcinomas were frequently located in the lower third of the stomach compared with poorly differentiated gastric carcinomas (65.7 vs. 55.8%).

A depth of invasion greater than T3 was found more frequently in stomachs removed from the poorly differentiated gastric carcinoma group than from the well-differentiated type group (52.6 vs. 30.3%; P < 0.001). Lymph node invasion above the N2 group was more frequent in the poorly differentiated gastric carcinoma group than in the well-differentiated group (18.2 vs. 9.1%; P < 0.001). In the well-differentiated gastric carcinoma group, 221 cases (80.7%) were classified as either Stage I or II at the time of initial diagnosis. In contrast, 36.4% of the patients in the poorly differentiated gastric carcinoma group were classified as advanced stage (Stage III or higher; P < 0.001).

[Table 2] shows a statistically significant prognostic value of histologic differentiation. Using Cox's proportional hazard regression model, histologic differentiation was found to be a statistically significant prognostic parameter (risk ratio, 1.41; 95% confidence interval, 1.028-1.922; P < 0.05) [Table 3]. The Kaplan-Meier survival curves for the two groups are shown in [Figure 1]. The overall survival rate was higher for patients with a well-differentiated gastric carcinoma than for patients with a poorly differentiated type. [Figure 2] shows the survival curves of gastric carcinoma patients with curative resection according to the histologic differentiation after adjusting for age, sex and TNM stage.
Table 2: Prognostic value of histologic differentiation

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Table 3: Prognostic value of histologic differentiation after adjustment for age, sex and TNM stage

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Figure 1: Survival curves of gastric carcinoma patients with curative resection according to the histologic differentiation

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Figure 2: Survival curves of gastric carcinoma patients with curative resection according to the histologic differentiation after adjustment for age, sex and tumor-node-metastasis stage

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 » Discussion Top


The depth of invasion and the presence or absence of the lymph node metastasis are the most important clinicopathologic factors influencing the prognosis of patients with gastric carcinoma.[5],[6],[7],[8] Although many studies of the prognostic factors in patients with gastric carcinoma have been reported, only a few have examined the histologic differentiation of the carcinomas. Therefore, we analyzed the clinicopathologic features of gastric carcinoma patients undergoing curative resection according to the histologic differentiation and surgical outcome.

Adachi et al.[9] reported that well-differentiated and poorly differentiated gastric carcinomas differed according to patient age and gender, tumor location and size and site of metastases or recurrences. In this study, we confirmed that well-differentiated and poorly differentiated gastric carcinomas differed in the mean age, gender, mean tumor size, tumor location, depth of invasion, extent of lymph node involvement and tumor stage at initial diagnosis. The differences based on morphologic and pathologic differences between well-differentiated and poorly differentiated gastric carcinomas were attributable not only to the biological behavior of carcinoma cells, but also to the vascular architecture of the tumor stroma.[10]

Lymph node metastasis is thought to be an important prognostic factor in carcinoma of the stomach. In this study, the lymph node metastasis rate in poorly differentiated gastric carcinomas was higher than in well-differentiated carcinomas, corroborating the finding of Adachi et al.[9]

The use of histologic differentiation as a prognostic factor is another controversial subject, although several studies have examined the prognostic relevance of histologic grade in patients with gastric carcinoma. Noda et al.[11] evaluated gastric carcinoma patients based on the Lauren classification and found that the 5-year survival rate was lower in patients with diffuse carcinoma than in those with intestinal carcinoma. Ribeiro et al.[12] also reported that the 5-year survival rate was lower in patients with diffuse carcinoma than in those with intestinal carcinoma and was higher in patients with expanding carcinoma than in those with infiltrative carcinoma. Davessar et al.[13] demonstrated that both Lauren and Ming classification systems had prognostic value in patients with gastric carcinoma. Although the histologic grade did not significantly influence the prognosis,[14] some reports have suggested that histologic grade is associated with the prognosis of gastric carcinoma. Adach et al.,[9] Moriguchi et al.[15] and Bruno et al.[16] reported that histologic type (well-differentiated vs. poorly differentiated) was one of the independent prognostic factors considering pathologic tumor variables. They believed that histologic type was important for estimating the prognosis of patients with gastric carcinoma. Kunisaki et al.[17] recommended that therapeutic strategies should be based on the histological type of the tumor in patients with poorly differentiated gastric carcinoma. We also found that histologic grade was important for estimating the prognosis of patients with gastric carcinoma using a multivariate analysis. In our study, the overall 5-year survival rate was higher in patients with well-differentiated gastric carcinoma than in those with the poorly differentiated type because patients with the poorly differentiated type had more prominent serosal invasion, much more lymph node involvement and more advanced stage than patients with the well-differentiated type.


 » Conclusion Top


This study demonstrated that that histologic differentiation is important for estimating the prognosis of patients with gastric carcinoma. Therefore, histologic differentiation can be used clinically to predict survival after curative resection of gastric carcinoma.

 
 » References Top

1.
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.  Back to cited text no. 1
[PUBMED]    
2.
Ming SC. Gastric carcinoma. A pathobiological classification. Cancer 1977;39:2475-85.  Back to cited text no. 2
[PUBMED]    
3.
American Joint Committee on Cancer. In: Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al., editors. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer; 2002.  Back to cited text no. 3
    
4.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma-2nd English edition. Gastric Cancer 1998;1:10-24.  Back to cited text no. 4
[PUBMED]    
5.
Bozzetti F, Bonfanti G, Morabito A, Bufalino R, Menotti V, Andreola S, et al. A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet 1986;162:229-34.  Back to cited text no. 5
[PUBMED]    
6.
Hermanek P. Prognostic factors in stomach cancer surgery. Eur J Surg Oncol 1986;12:241-6.  Back to cited text no. 6
[PUBMED]    
7.
Adachi Y, Ogawa Y, Sasaki Y, Yukaya H, Mori M, Sugimachi K. A clinicopathologic study of gastric carcinoma with reference to age of patients. J Clin Gastroenterol 1994;18:287-90.  Back to cited text no. 7
    
8.
Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: Ten-year results of the German gastric cancer study. Ann Surg 1998;228:449-61.  Back to cited text no. 8
    
9.
Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S. Pathology and prognosis of gastric carcinoma: Well versus poorly differentiated type. Cancer 2000;89:1418-24.  Back to cited text no. 9
    
10.
Adachi Y, Mori M, Enjoji M, Sugimachi K. Microvascular architecture of early gastric carcinoma. Microvascular-histopathologic correlates. Cancer 1993;72:32-6.  Back to cited text no. 10
    
11.
Noda S, Soejima K, Inokuchi K. Clinicopathological analysis of the intestinal type and diffuse type of gastric carcinoma. Jpn J Surg 1980;10:277-83.  Back to cited text no. 11
[PUBMED]    
12.
Ribeiro MM, Sarmento JA, Sobrinho Simões MA, Bastos J. Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma. Cancer 1981;47:780-4.  Back to cited text no. 12
    
13.
Davessar K, Pezzullo JC, Kessimian N, Hale JH, Jauregui HO. Gastric adenocarcinoma: Prognostic significance of several pathologic parameters and histologic classifications. Hum Pathol 1990;21:325-32.  Back to cited text no. 13
    
14.
Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 1992;70:1030-7.  Back to cited text no. 14
    
15.
Moriguchi S, Kamakura T, Odaka T, Nose Y, Maehara Y, Korenaga D, et al. Clinical features of the differentiated and undifferentiated types of advanced gastric carcinoma: Univariate and multivariate analyses. J Surg Oncol 1991;48:202-6.  Back to cited text no. 15
    
16.
Bruno L, Nesi G, Montinaro F, Carassale G, Boddi V, Bechi P, et al. Clinicopathologic characteristics and outcome indicators in node-negative gastric cancer. J Surg Oncol 2000;74:30-2.  Back to cited text no. 16
    
17.
Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, et al. Clinicopathological properties of poorly-differentiated adenocarcinoma of the stomach: Comparison of solid- and non-solid-types. Anticancer Res 2006;26:639-46.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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