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Objective:Analyze the correlation between serum immunoglobulin G (IgG) N-glycan and Lauren classification of gastric cancer.Methods:A retrospective study was performed on 17 patients with diffuse type gastric cancer and 21 patients with intestinal type who received treatment in Zhongshan Hospital from 2017 to 2018, and the general medical history data and disease characteristics were summarized. The serum IgG glycome profiles were analyzed by ultraperformance liquid chromatography, and the difference between intestinal type and diffuse type gastric cance was compared.Logistic regression was used to evaluate the correlation between serum IgG N-glycan and Lauren classification.Results:IgG N-glycome analysis included 27 directly detected glycans and 4 derived traits. H=Hexose, N=N-acetylglucosamine, F=Fucose, S=Sialic acid.There was no significant difference in IgG N-glycan among different chemotherapy protocol. Compared with intestinal type, H3N3F1 ( t=3.785, P=0.001), H3N4( t=3.919, P=0.002), H3N4F1( t=2.770, P=0.005), H3N5F1( t=2.888, P=0.010) were decreased in diffuse type; H4N4F1(6)( t=?3.488, P<0.001), H5N4F1( t=?3.401, P=0.003), H5N5F1( t=?2.303, P=0.023), H5N4F1S1 ( t=?3.068, P=0.008) were increased.H3N3F1( OR:1.20, P=0.008), H3N4( OR:1.32, P=0.005), H3N4F1 ( OR:1.13, P=0.017), H3N5F1 ( OR:1.78, P=0.015), H4N4F1(6)( OR:0.43, P=0.008), H5N4F1(6)( OR:0.74, P=0.008), H5N5F1 ( OR:0.32, P=0.036), H5N4F1S1( OR:0.48, P=0.009) were significantly correlated with Lauren classification. Sialylated ( t=?2.717, P=0.012) and galactosylated ( t=?3.400, P=0.001) IgG N-glycan were reduced in patients with intestinal type gastric cancer.Galactosylated ( OR:0.87, P=0.007) and sialylated ( OR:0.62, P=0.015) IgG N-glycan were significantly correlated with Lauren classification. Conclusion:Some IgG N-glycan are significantly correlated with Lauren classification, which can be used as potential biomarkers.
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Objective:To study the value of metastatic lymph node radio (rN) and pathological lymph node stage (pN) in evaluating the prognosis of patients after radical gastric cancer.Methods:The clinicopathological data of 491 patients who underwent radical gastrectomy in Tantai Yantaishan Hospital from Jan. 2013 to Dec. 2017 were retrospectively analyzed. X-tile software was used to group the metastatic lymph node radio by rN. According to the number of lymph node metastasis, pN stage was performed. The correlation between metastatic lymph node radio and other clinicopathological factors was assessed. The metastatic lymph node radio and the pathological lymph node stage in evaluating the prognosis of patients after radical gastric cancer were compared.Results:(1) X-tile analysis showed that the best cut-off values for the metastatic lymph node radio in this study were 0.14 (14%) and 0.63 (63%) . (2) According to the cut-off value, the 491 patients included in the study were divided into rN1 (256 cases) , rN2 (160 cases) , and rN3 (75 cases) three subgroups. The results of the analysis of differences showed that there were significant differencesbetween the groups in terms of tumor diameter, tumor location, surgical resection range, stage, lauren classification, degree of differentiation, pT, pN, vascular cancer emboulus, nerve invasion, and pathological TNM staging groups. (3) Comparison of rN and pN staging in evaluation of the prognosis of patients after radical gastric cancer: ①Kaplan-Meier survival analysis results showed that rN was better than pN. ② Both single factor and multivariate cox analysis showed that rN was an independent risk factor for the prognosis of gastric cancer. In univariate analysis, rN group HR=3.18 (95% CI 2.63-3.84, P<0.001) , pN stage HR=1.88 (95% CI 1.66-2.15, P<0.001) ; rN group HR=2.21 in multivariate analysis (95% CI 1.73-2.82, P<0.001) , pN staging HR=1.31 (95% CI 0.95-1.79, P=0.095) . ③The time-dependent ROC analysis showed that the prognostic ability of rN was better than pN staging before 52 months of postoperative follow-up, and pN staging was more advantageous after 52 months. ④The Lauren classification was used as a stratification factor for stratified analysis. The Kaplan-Meier survival curve indicated that rN was better than pN staging in intestinal, mixed and diffuse gastric cancer, and the AUC curve showed the prediction of rN in patients with mixed and diffuse gastric cancer was better than pN staging, while pN staging performance was slightly better in patients with intestinal gastric cancer. Conclusions:rN is an independent factor affecting the prognosis of patients after radical gastric cancer surgery. When judging the prognosis of patients within 52 months after radical gastric cancer, rN has a better prognostic value than pN. In patients with mixed and diffuse gastric cancer in the Lauren classification, rN shows better prognostic value.
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Objective@#To compare the clinicopathologic features and prognosis of the subtypes in a consecutive series of gastric cancers (GC) patients basing on the revised Lauren′s classification so as to better understand the biological behavior of GC.@*Methods@#The surgically resected GC from Peking Union Medical College Hospital during 2003-2005 were reviewed for patients′ age, gender, tumor size, location, Borrman classification, depth of invasion, lymph node metastasis, vascular invasion, and tumor growth pattern (Ming classification).@*Results@#One hundred and sixty-six GC cases were enrolled and classified into four groups: intestinal GC (30, 18.1%), diffuse GC (56, 33.7%), solid GC (9, 5.4%), and mixed GC (71, 42.8%). Intestinal GC patients were older[ (63.2±11.3) years], with a male predominance, and were more frequently found in the antrum. Intestinal GC was the most common subtype for early GC, and tend to develop liver metastases. Diffuse GC patients were youngest [(52.2±12.7) years], with no gender difference, and were usually found in the antrum. Microscopically, diffuse GC were more likely infiltrative (51/56, 91.1%), and tended to metastasize by lymphatic pathway. Solid GC were usually large[ (6.4±2.2) cm], with a male predominance, and the most frequent site was the body/fundus. Solid GC were more likely to show expansile growth pattern with greater depth of invasion (8 of 9 cases were T3/4), but lower rate of lymphatic metastasis. Mixed GC also showed a male predominance, usually found in the antrum, and showed an infiltrative growth pattern (49/71, 69.0%). Though there was fewer T3/4 than solid and diffuse GC, mixed GC were more likely to show lymph nodes, vascular metastases and liver metastases (13/71, 18.3%). TNM staging, lymph nodes metastasis, lymphovascular invasion and revised Lauren′s classification were four independent prognostic factors on multivariate analysis(P<0.05). The survival of patients with mixed GC were significantly worse than patients with other histological types.@*Conclusion@#Revised Lauren′s classification for GC has four distinct subgroups and can be used as independent prognostic factors.
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Objective The objectives of this study were to compare the clinicopathological features of different Lauren type gastric cancer,to carry out survival analysis,and to screen the prognostic factors.Methods The clinical pathologic data of gastric cancer patients who underwent surgical treatment at the Affiliated Tumor Hospital of Harbin Medical University from January 1,2007 to June 30,2007 were retrospectively analyzed.The 633 cases of gastric cancer patients were divided into intestinal type gastric cancer and diffuse type of gastric cancer groups,which were analyzed clinical and pathological characteristics and survival.Results Compared with diffuse type of gastric cancer,the proportion of intestinal type gastric cancer was slightly high(51.66% vs. 48.34%),the proportion of male was also high(2.94:1 vs.2.03:1,P=0.035).These could be more often in elderly patients age(≥60 years)(54.43% vs.35.94%,P<0.001).The prognosis of intestinal type gastric cancer was significantly better than diffuse gastric cancer(median survival time:90.9 months vs.37.33 months, P=0.014).Multivariate analysis showed that age ≥60 years old,CA199 abnormalities,larger tumors,poor differ-entiation,serosal invasion,initial lymph node metastasis,palliative surgery and non-pyloric resection were poor prognostic factors in gastric cancer.Conclusion Lauren type can be better respond to the clinicopathological fea-tures of different gastric cancer and guide to the prognosis.
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Objective The objectives of this study were to compare the clinicopathological features of different Lauren type gastric cancer,to carry out survival analysis,and to screen the prognostic factors.Methods The clinical pathologic data of gastric cancer patients who underwent surgical treatment at the Affiliated Tumor Hospital of Harbin Medical University from January 1,2007 to June 30,2007 were retrospectively analyzed.The 633 cases of gastric cancer patients were divided into intestinal type gastric cancer and diffuse type of gastric cancer groups,which were analyzed clinical and pathological characteristics and survival.Results Compared with diffuse type of gastric cancer,the proportion of intestinal type gastric cancer was slightly high(51.66% vs. 48.34%),the proportion of male was also high(2.94:1 vs.2.03:1,P=0.035).These could be more often in elderly patients age(≥60 years)(54.43% vs.35.94%,P<0.001).The prognosis of intestinal type gastric cancer was significantly better than diffuse gastric cancer(median survival time:90.9 months vs.37.33 months, P=0.014).Multivariate analysis showed that age ≥60 years old,CA199 abnormalities,larger tumors,poor differ-entiation,serosal invasion,initial lymph node metastasis,palliative surgery and non-pyloric resection were poor prognostic factors in gastric cancer.Conclusion Lauren type can be better respond to the clinicopathological fea-tures of different gastric cancer and guide to the prognosis.
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Objective To explore the value of gemstone spectral imaging (GSI)in quantitative evaluation of Lauren classification of gastric cancer.Methods Fifty-two patients with gastric cancer confirmed by gastroscopy underwent contrast-enhanced spectral CT imaging preoperatively.The monoergic and iodine-based images were obtained by GSI Viewer software,CT value and iodine concentration (IC)of the lesions were measured,and normalized iodine concentration (NIC)was calculated.With the reference of postoperative pathology,data were analyzed by LSD method of one-way analysis of variance.Results The IC,NIC,spectrum curve slope of 40-70 keV,40-140 keV and 70-140 keV energy range of intestinal type,mixed type and diffuse type carcinoma in the arterial phase were 12.86±6.80 (100 μg/mL),0.13±0.06 ,2.50±1.26 ,0.99±0.51 ,0.34±0.20 ,18.54±6.49 (100 μg/mL),0.19±0.07, 3.56±1.24,1.42±0.50,0.50±0.18 and 24.52±9.68 (100 μg/mL),0.24±0.09,4.73±1.76,1.90±0.73,0.68±0.29,respectively. The values of intestinal type were all significantly lower than those of diffuse type (P <0.05).Comparison between intestinal-mixed type and mixed-diffuse type,the other parameters were no significant differences except IC between intestinal-mixed type (P=0.037).Conclusion The slope of spectrum curve,iodine concentration,and normalized iodine concentration could be helpful for preoperative evaluation of Lauren classification of gastric cancer.
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Objective:To investigate the correlations of Lauren classification and world health organization (WHO) classification of gastric cancer (GC) with microvascular density (MVD), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 1 (VEGFR1), vascular endothelial growth factor receptor 2 (VEGFR2), and p53. Methods:The clinical data of 89 patients with GC were collected. The collected specimens were categorized on the basis of Lauren classification and WHO classification. CD34/periodic acid-Schiff (PAS) double staining was performed to validate MVD. Immunohistochemistry was conducted to investigate the expression levels of MMP-2, MMP-9, VEGF, VEGFR1, VEGFR2, and p53. Results:MVD was not correlated with Lauren classification or WHO classification (P>0.05). Lauren typing was associated with the expression levels of MMP-9, VEGFR1, and p53 (P0.05). Cox proportional hazards model revealed that Lauren classification and WHO classification were the prognostic factors of overall survival (P<0.05). Conclusion:This research on tumor related factors, angiogenesis, and different classifications of GC may provide new methods to treat this disease.
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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.
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Humans , Adenocarcinoma , Classification , Cohort Studies , Gastrectomy , Multivariate Analysis , Prognosis , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
ObjectiveTo explore the value of virtual touch tissue quantification (VTQ) in evaluating Lauren classification of advanced gastric carcinoma.MethodsForty-one patients with gastric cancer proved by endoscopic biopsy performed preoperative VTQ examination,and the findings were compared with postoperative pathologic results via hematoxylin -eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining.ResultsIn 41 patients,26 cases were diagnosed as diffuse type and 15 cases as intestinal type by pathology after operation.The shear wave velocity(SWV) of diffuse type was higher than that of intestinal type [(1.72± 0.83)m/s vs (1.05± 0.66)m/s,t =2.819,P=0.008] measured by virtual touch tissue quantification (VTQ).According to the area under the ROC curve,the cut- off value of SWV in gastric cancer tissues for assessing the diffuse type was 1.045 m/s with a sensitivity of 80.8％ and specificity of 73.3 ％ respectively.ConclusionsVTQ could be considered as a promising method to distinguish the Lauren classification in patients with advanced gastric carcinoma.
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Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS)in diagnosing Lauren classification of advanced gastric carcinoma.Methods Fifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination,and the findings were compared with postoperative pathologic results via hematoxylin-eosin and alcian blue-periodic acid schiff(AB-PAS)staining.Results In 58 patients,34 cases were diagnosed as intestinal type and 24 cases as diffuse type by pathology after operation.In intestinal type,30 cases were enhanced as global homogeneous intensity by using DCUS.another 2 cases as"lamellar"model and the other 2 cases as heterogeneous intensity.However,in diffuse type,22 cases were enhanced heterogeneously with"barrier"signs in 5 cases,"map"signs in 9 cases and"lamellar"signs in 8 cases.the remaining 2 cases of diffuse type enhanced as homogeneous model.The sensitivity and specificity of heterogeneous enhancement in diagnosing diffuse type of advanced gastric cancer was 91.7%and 88.2%respectively,and the Youden's index was 0.8.Conclusions DCUS could be considered as a new valuable method to distinguish the Lauren classification and evaluate the invasiveness,metastasis and prognosis in patients with gastric carcinoma.
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PURPOSE: E-cadherin (ECD) plays a pivotal role in integrating the normal tissue architecture and the suppression of cancer invasion, including stomach cancer. The epidemiology of stomach cancers is noticeably different according to the site of the index tumor, even though the stomach cancers all have similar gross shapes. In this study, the relation between the expression of ECD, along with the clinicopathologic parameters and recurrence or survival, were investigated for patients with gastric adenocarcinoma according to the tumor location. METHODS: We examined formalin-fixed, paraffin-embedded archival tissues from 50 surgically resectable gastric adenocarcinomas, which were grouped by the index tumor site as follows: distal (antrum) versus proximal (mid and upper body). To elucidate the correlation between the ECD expression and the site of the stomach cancer with the other clinicopathologic factors, we examined the ECD tissue status via performing immunohistochemistry. To compare the rates of recurrence and survival among subgroups, the patients were followed up for an average of 42 months. RESULTS: Among the 50 tumors examined, 28 (56%) tumors showed various degrees of a ECD expression. The gender, age, size, depth of invasion, lymph node metastasis, stage, lymphatic invasion and vascular invasion were not related with the ECD expression. The Lauren classification was cor-related with the ECD expression in the mid and upper body stomach cancer, but not in the antral stomach cancer (P=0.042). The expression of ECD was not related with the survival rate (P=0.223). There was no significant difference in the recurrence rate between the subgroups with and without an abnormal expression of ECD (P=0.588). CONCLUSION: For the mid and upper body stomach cancer, the expression of E-cadherin correlated with the diffuse type of cancer, according to the Lauren classification, but not with the survival rate.
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Humans , Adenocarcinoma , Cadherins , Classification , Epidemiology , Immunohistochemistry , Lymph Nodes , Neoplasm Metastasis , Recurrence , Stomach Neoplasms , Stomach , Survival RateABSTRACT
Molecular investigations have provided evidence of the involvement of multiple genetic alterations in gastric carcinogenesis. Regarding the clinical, epidemiological and genetic aspects, well and poorly differentiated gastric adenocarcinoma exhibit some differences.(1) PURPOSE: To examine the gene expression profile of stomach cancer and evaluate the differentially expressed genes between intestinal and diffuse cancer type. METHODS: Five intestinal and 5 diffuse type gastric cancer tissues and their matched normal mucosa were obtained from patients who underwent a gastrectomy. The mRNAs frome these tissues were extracted, reverse transcribed with simultaneous Cy3 and Cy5 labeling, and hybridized with the MAGIC(TM) microarray (Korean 4.6k chip). The chip was scanned using Generation III, image analysis with Imagine 5.0 and data analysis with Arraytool, R, and SAM. RESULTS: Twelve and 15 genes were found to be up- and down-regulated genes in the intestinal type, whereas these figures were 25 and 4 genes in the diffuse type, respectively. With the intestinal and diffuse type, 2 and 9, 10 and 4 exhibites up- and down-regulation greater than 2 fold, respectively. In the intestinal type genes, up-regulation was associated with metabolism, cell growth and cell communication; whereas, down-regulation was associated with metabolism and mainly unclassified functions. In the diffuse type genes, up-regulation was associated with metabolism, cell growth, cell communication and drug resistance, ; whereas, down-regulation was associated with metabolism and cell growth. Non-hierarchical clustering of the genes revealed two expression profiles, which can be used to classify the above 10 samples into two exactly distinct types. CONCLUSION: The analysis of the intestinal and diffuse gastric cancers using the cDNA microarray showed distinct gene expression profiles, consistent with their different histological and clinical features.
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Humans , Adenocarcinoma , Carcinogenesis , Cell Communication , DNA, Complementary , Down-Regulation , Drug Resistance , Gastrectomy , Gene Expression , Metabolism , Mucous Membrane , Oligonucleotide Array Sequence Analysis , RNA, Messenger , Statistics as Topic , Stomach Neoplasms , Transcriptome , Up-RegulationABSTRACT
Objective To investigate the role of the classification of Lauren in staging of gastric carcinoma and preoperative assessment using spiral CT. Methods Forty eight patients, 32 men and 16 women, who were 24～78 years old, with histologically and endoscopically proven gastric carcinoma, underwent spiral CT scans in prone position, with drug induced hypotonia and water filling. To induce gastric wall hypotonia and to maintain it during the entire examination, 10～15 mg of 654 2 was administered iv before basal scanning. All patinets underwent 2D, 3D and axial imaging using spiral CT, and 46 patients underwent dual phase contrast within one breathhold each. All patients with gastric carcinoma underwent staging and preoperative assessment by two radiologists according to the classification of Lauren. Results Spiral CT correctly detected all tumours. In our series, gastric carcinoma was of the diffuse type in 33 cases, of intestinal type in 15 cases; first stage in 2 cases, second stage in 18 cases, third stage in 15 cases and forth stage in 13 cases. There were 40 patients being performed operation, gastrectomy was performed in 33 patients and laparotomy was performed in 7 patients. The staging and preoperative assessment accuracy was 85.4% and 95.0% respectively, overstaging was 10.4%, and understaging was 4.2% according to the classification of Lauren. Correct rate of spiral CT detected lymph nodes (N1,N2) was 74.1% and 82.7% respectively. There are about 18 patienes whose arteries were invaded by tumors. With dual phase contrast, spiral CT can get well in detecting tumour, especially in staging gastric carcinoma in artery phase. Conclusions The classification of Lauren is recommended for staging of gastric carcinoma and preoperative assessment using spiral CT.
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This study was carried out to investigate the immunohistochemical expression of bcl-2 and p53 protein in the intestinal type and the diffuse type of gastric adenocarcinoma by Lauren's classification. A total of 100 cases, including 50 cases of the intestinal type and 50 cases of the diffuse type from paraffin embedded gastrectomy specimens, were immunohistochemically stained for bcl-2 and p53 protein. Bcl-2 protein was expressed in 38% (19/50) of intestinal type and 30% (15/50) of diffuse type. The incidence of bcl-2 protein expression was higher in the intestinal type than in the diffuse type, but no significant correlation was present (p>0.05). p53 protein was expressed in 68% (34/50) of the intestinal type and 60% (30/50) of the diffuse type. The incidence of p53 protein expression was higher in the intestinal type than in the diffuse type, but no significant correlation was present (p>0.05). And an expression of bcl-2 and p53 protein did not correlate with depth of invasion, lymph node meatastasis and TNM stage, respectively (p>0.05). These results suggest that bcl-2 and p53 gene alteration appear to play a more important role in the carcinogenesis of the intestinal type than the diffuse type. However, there is no significant difference between the intestinaPU: The Korean Society of Pathologistsl type and the diffuse type in bcl-2 and p53 protein expression.