Dixon M F, Martin I G, Sue-Ling H M, Wyatt J I, Quirke P, Johnston D
Academic Unit of Pathology, University of Leeds, UK.
Histopathology. 1994 Oct;25(4):309-16. doi: 10.1111/j.1365-2559.1994.tb01348.x.
A novel grading method which utilises intra-cellular mucin content and tubular differentiation (the Goseki grade) has been applied to 181 gastric cancers removed in potentially curative resections, and compared to conventional tumour grading (well, moderate, poor differentiation) and the Lauren, Ming and WHO classifications. The Goseki grade is significantly related to patient survival and, unlike the existing approaches, remains so after allowing for tumour stage in multivariate analyses. Potential relationships between the Goseki grade, direct tumour spread, lymph node involvement and survival have been investigated. Prognosis is particularly related to mucin content; 55% of patients with mucin-rich tumours dying within 5 years compared to 29% of those with mucin-poor cancers. A smaller proportion of mucin-poor cancers show lymph node involvement (N1 and N2) than mucin-rich tumours (52% v. 73%) and a smaller proportion of cancers showing good tubular differentiation exhibit widespread lymph node involvement (N2) than tubule-poor cancers (11% v. 28%). However, these differences did not achieve statistical significance. When compared to the existing classification or grading methods, the Goseki grade was found to be highly significantly correlated with the WHO and Lauren classifications and to conventional grading, but not to the Ming classification. These inter-relations are largely dependent upon tubular differentiation. There was no relationship between Goseki grade and the lymphocytic response around the tumour margin. Inter-observer agreement on the WHO type and the Lauren, Ming and Goseki grading methods was tested on 70 randomly selected cases.(ABSTRACT TRUNCATED AT 250 WORDS)
一种利用细胞内黏液含量和管状分化的新型分级方法（戈塞基分级）已应用于181例接受潜在根治性切除的胃癌，并与传统肿瘤分级（高分化、中分化、低分化）以及劳伦、明和世界卫生组织分类法进行了比较。戈塞基分级与患者生存率显著相关，并且与现有方法不同的是，在多变量分析中考虑肿瘤分期后依然如此。已对戈塞基分级、肿瘤直接扩散、淋巴结受累和生存率之间的潜在关系进行了研究。预后尤其与黏液含量有关；黏液丰富肿瘤的患者中有55%在5年内死亡，而黏液缺乏癌症患者的这一比例为29%。黏液缺乏癌症出现淋巴结受累（N1和N2）的比例低于黏液丰富肿瘤（52%对73%），且管状分化良好的癌症出现广泛淋巴结受累（N2）的比例低于管状分化差的癌症（11%对28%）。然而，这些差异未达到统计学意义。与现有的分类或分级方法相比，发现戈塞基分级与世界卫生组织和劳伦分类法以及传统分级高度显著相关，但与明分类法无关。这些相互关系在很大程度上取决于管状分化。戈塞基分级与肿瘤边缘周围的淋巴细胞反应之间没有关系。对70例随机选择的病例测试了观察者之间关于世界卫生组织类型以及劳伦、明和戈塞基分级方法的一致性。（摘要截短于250字）
