Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S
First Department of Surgery, Oita Medical University, Oita, Japan.
Cancer. 2000 Oct 1;89(7):1418-24.
The most important parameters predicting outcome of patients with gastric carcinoma are the depth of wall invasion and the status of lymph node metastasis, but the prognostic significance of histologic type is unclear. The aim of this study was to clarify the prognostic value of two major histologic types of gastric carcinoma, that is well and poorly differentiated types.
Histopathologic findings and outcomes of 504 patients with gastric carcinoma were evaluated by well and poorly differentiated types. Well differentiated gastric carcinoma (WGC) included papillary and tubular adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma; whereas poorly differentiated gastric carcinoma (PGC) included poorly differentiated scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous carcinoma.
Patients with WGC were characterized by old age, male predominance, tumor location in the lower third of the stomach, small tumor size, and liver metastasis; whereas patients with PGC were distinguished by their tumor location in the middle third of the stomach, serosal invasion, lymph node metastasis, advanced stage, and peritoneal dissemination. The overall 5-year survival rate for patients with WGC was higher than that for patients with PGC (76% vs. 67%; P = 0.058), especially for patients with >/= 10 cm tumors (42% vs. 14%; P = 0.017). The 5-year survival rate for patients with serosa positive but node negative tumors was higher in WGC patients than in PGC patients (83% vs. 59%; P = 0.086); whereas the 5-year survival rate for patients with serosa negative but node positive tumors was lower in WGC patients than in PGC patients (63% vs. 88%; P = 0.008). Multivariate analysis indicated that among pathologic variables of the tumor, histologic type (WGC vs. PGC) was one of the independent prognostic factors.
Histologic type is important for estimating the tumor progression and outcomes of patients with gastric carcinoma. In addition to the depth of wall invasion and status of lymph node metastasis, histologic type, including well or poorly differentiated type, should be evaluated in the management of gastric cancer.
预测胃癌患者预后的最重要参数是壁层浸润深度和淋巴结转移状况，但组织学类型的预后意义尚不清楚。本研究的目的是阐明胃癌两种主要组织学类型，即高分化型和低分化型的预后价值。
根据高分化型和低分化型对504例胃癌患者的组织病理学结果和预后进行评估。高分化胃癌（WGC）包括乳头状腺癌、管状腺癌、低分化髓样癌和高分化黏液癌；而低分化胃癌（PGC）包括低分化硬癌、印戒细胞癌和低分化黏液癌。
WGC患者的特点是年龄较大、男性居多、肿瘤位于胃下三分之一、肿瘤体积小和肝转移；而PGC患者的特点是肿瘤位于胃中三分之一、浆膜侵犯、淋巴结转移、晚期和腹膜播散。WGC患者的总体5年生存率高于PGC患者（76%对67%；P = 0.058），尤其是肿瘤≥10 cm的患者（42%对14%；P = 0.017）。浆膜阳性但淋巴结阴性的肿瘤患者，WGC患者的5年生存率高于PGC患者（83%对59%；P = 0.086）；而浆膜阴性但淋巴结阳性的肿瘤患者，WGC患者的5年生存率低于PGC患者（63%对88%；P = 0.008）。多因素分析表明，在肿瘤的病理变量中，组织学类型（WGC对PGC）是独立的预后因素之一。
组织学类型对评估胃癌患者的肿瘤进展和预后很重要。除了壁层浸润深度和淋巴结转移状况外，在胃癌治疗中还应评估包括高分化或低分化类型在内的组织学类型。
