GASTRIC CANCER: THE IMPORTANCE OF PATHOLOGY IN SURVIVAL AFTER RESECTION
Abstract:
Background: Lymph node ratio and lymph node status are the most important prognostic factors in the patients with gastric carcinoma, and the depth of wall invasion, and the prognostic significance of the histological type is unclear. The extent of stomach resection in gastric cancer depends on tumour size, tumour location, depth of invasion, and the histological allocation to intestinal or diffuse type according to Laurén. The aim of this study was to determine the prognostic value of the intestinal and diffuse histological types of gastric carcinoma, and of the well and poorly differentiated types. Material and method: In this study, we histopathologically assessed 252 patients with gastric cancer, by well and poorly differentiated type. Well differentiated carcinoma of the stomach included tubular and papillary adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma (WDGC). For poorly differentiated carcinoma, we included the scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous gastric carcinoma (PDGC). Results: In the patients with PDGC, the tumour was located in the middle third of the stomach, with lymph node metastasis, serosal invasion (T3-T4), and peritoneal carcinomatosis (rarely). The patients with WDGC were with the tumour located in the lower third of the stomach, small tumour size and liver metastasis. The 5-year survival rate with serosa positive tumours, but with lymph node negative, was in WDGC of 32% vs. 28% in PDGC. p=0,086. The 5-year survival rate in the patients with serosa negative, but lymph node positive cancer, was of 28% in WDSC, vs. 29% in PDGC, p=0.008. The overall 5-year survival rate for the patients with WDGC was of 29% vs. 21% in PDGC. p=0,058, situation visible in tumours ≥ 10 cm, (21% vs. 14%, p=0,017). Multivariate analysis indicated that from the pathological point of view, tumour satus, histological type (WDGC vs. PDGC) were independent prognostic factors. Conclusions. Histological type is on indicator for tumour progression in gastric carcinoma. In the management of the gastric carcinoma, the histological type of tumour, (well and poorly differentiated), the depth of wall infiltration, and the status of the lymph node (N+,N-), as well as the size of the tumour (≥5cm, ≥10cm) should be evaluated.
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