Abstract
In 351 patients with gastric carcinomas resected for cure, the relationship between macroscopic and microscopic features and survival was studied by univariate and multivariate analyses. In the multivariate survival analysis with covariates according to the Cox regression model, in early cancer all significant correlations to survival rate are covered by the stage grouping according to the UICC schedule of 1987. In advanced gastric carcinoma the UICC stage and, in addition, the Borrmann type and the intensity of cellular infiltration are effective. By additional consideration of these two variables an extended pathological staging schedule is proposed. It has the advantage of better discrimination between patients who differ in prognosis and seems to improve the prognostic prediction of outcome. Testing of this extended staging system in larger collectives is recommended.
Key Words: Gastric carcinoma, Morphology, Survival analysis
Footnotes
This study was performed in conjunction with the German Gastric Cancer TNM Study Group and supported by the German Ministery of Science and Technology (BMFT) (no 0701908)
References
- Baba H, Korenaga D, Okamura T, Saito A, Sugimachi K (1989) Prognostic factors in gastric cancer with serosal invasion. Univariate and multivariate analysis. Arch Surg 124:1061–1064 [DOI] [PubMed] [Google Scholar]
- Bedikian AY, Chen TT, Khankhanian N, Heilbrun LK, McBride CM, McNurtrey MJ, Bodey GP (1984) The natural history of gastric cancer and prognostic factors influencing survival. J Clin Oncol 2:305–310 [DOI] [PubMed] [Google Scholar]
- Bennett SH, Futrell JW, Roth JA, Hoye RC, Ketcham AS (1971) Prognostic significance of histologic host response in cancer of the larynx and hypopharynx. Cancer 28:1255–1265 [DOI] [PubMed] [Google Scholar]
- Berg J (1959) Inflammation and prognosis in breast cancer. Cancer 12:714–720 [DOI] [PubMed] [Google Scholar]
- Black MM, Freeman C, Mork T, Harvel S, Cutler SJ (1971) Prognostic significance of microscopic structure of gastric carcinoma and their regional lymph nodes. Cancer 27:703–711 [DOI] [PubMed] [Google Scholar]
- Curtis RE, Kennedy BJ, Mayers MH, Honkey BF (1983) Evaluation of AJC stomach cancer staging using the SEER population. Semin Oncol 12:21–31 [PubMed] [Google Scholar]
- Davessar K, Pezzullo JC, Kessimian N, Hale JH, Jauregui HO (1990) Gastric adenocarcinoma, prognostic significance of several pathologic parameters and histologic classifications. Hum Pathol 21:325–332 [DOI] [PubMed] [Google Scholar]
- Di Paola M, Bertolotti A, Colizza S, Coli M (1977) Histology of bronchial carcinoma and regional lymph nodes as putative immune response of the host to the tumor. Thorac Cardiovasc Surg 73:531–537 [PubMed] [Google Scholar]
- Elias D, Lasser PH, Bognel C, Nadal JM, Rahal K, Pineda R, Rougier P (1988) Gastric adenocarcinoma surgically treated. A multivariate analysis of prognostic factors. Gastroenterol Clin Biol 12:729–735 [PubMed] [Google Scholar]
- Flamm J, Havelec L (1990) Factors affecting survival in primary superficial bladder cancer. Eur Urol 17:113–118 [DOI] [PubMed] [Google Scholar]
- Haferkamp O (1980) Inflammatory stromal reaction in well-differential adenocarcinoma of the large intestine. In: Grundmann E (ed) Metastatic tumor growth. Fischer, Berlin, pp 141–146 [Google Scholar]
- Halvorsen TB, Seim J (1989) Association between invasiveness, inflammatory reaction, desmoplasia and survival in colorectal cancer. J Clin Pathol 42:162–166 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hamlin IME (1968) Possible host resistance in carcinoma of the breast. A histological study. Br J Cancer 22:383–401 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Helliwell TR, Atkinson MW, Cooke TG, Cokke LD, Stell PM (1989) Morphometric analysis, ploidy and response to chemotherapy in squamous carcinomas of the head and neck. Pathol Res Pract 185:755–759 [DOI] [PubMed] [Google Scholar]
- Hermanek P (1982) Magenkarzinom. Chirurgische Pathologie, TNM-System. Langenbecks Arch Chir 358:57–63 [DOI] [PubMed] [Google Scholar]
- Hermanek P (1986) Prognostic factors in stomach cancer surgery. Eur J Surg Oncol 12:241–246 [PubMed] [Google Scholar]
- Hermanek P (1991) Die Bedeutung der TNM-Klassifikation für die Prognosebeurteilung operierter Magenkarzinompatienten. In: Delbrück H (ed) Krebsnachsorge und Rehabilitation, vol. III. Zuckschwerdt, München (in press) [Google Scholar]
- Hermanek P, Sobin LH (eds) (1987) UICC:TNM classification of malignant tumours. 4th eds, Springer, Berlin Heidelberg New York [Google Scholar]
- Jass JR (1986) Lymphocytic infiltrate and survival in rectum cancer. J Clin Pathol 39:585–589 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jass JR, Atkins WS, Cuzick J, Bussey HJR, Morson BC, Northover T, Todd IP (1986) The grading of rectal cancer. Histopathology 10:437–459 [DOI] [PubMed] [Google Scholar]
- Kayser K, Bülzebruck H, Ebert W, Merkle NM, Vogt-Moykopf I (1986) Local tumor inflammation, lymph node metastasis and survival of operated bronchus carcinoma patients. J Natl Cancer Inst 77:77–81 [PubMed] [Google Scholar]
- Krüger GRF (1985) Klinische Immunpathologie. Kohlhammer, Stuttgart [Google Scholar]
- Maruyama K (1986) Surgical treatment for advanced gastric cancer: an evaluation of systematic lymph node dissection. In: Gall FP, Hermanek P, Hornig D (eds) Magenkarzinom. Epidemiologie, Pathologie, Therapie, Nachsorge. Zuckschwerdt, München [Google Scholar]
- Maruyama K (1987) The most important prognostic factors for gastric cancer patients. Scand J Gastroenterol 22 [Suppl 133]:63–68 [Google Scholar]
- Maruyama K, Okabayashi K, Kinoshito T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425 [DOI] [PubMed] [Google Scholar]
- Ming SC (1977) Gastric carcinoma. A pathobiological classification. Cancer 39:2475–2485 [DOI] [PubMed] [Google Scholar]
- Miwa K, Japanese Research Society for Gastric Cancer (1984) Evaluation of the TNM classification of stomach cancer and proposal for its rational stage grouping. Jpn J Clin Oncol 14:385–410 [PubMed] [Google Scholar]
- Mostofi FK, Sesterhenn J (1976) Lymphocytic infiltration in relations to urologic tumors. Natl Cancer Inst Monogr 49:133–141 [PubMed] [Google Scholar]
- Msika S, Chastang C, Houry S, Lacaine F, Huguier M (1989) Lymph node involvement as the only prognostic factor in curative resected carcinoma: a multivariate analysis. World J Surg 13:118–123 [DOI] [PubMed] [Google Scholar]
- Munoz N, Correa P, Cuello C, Duque E (1968) Histologic types of gastric carcinoma in high an low ris areas. Int J Cancer 3:809–818 [DOI] [PubMed] [Google Scholar]
- Ohyama S, Yonemura Y, Miyazaki I (1990) Prognostic value of Sphase fraction and DNA ploidy studied with in vivo administration of bromodeoxyuridine on human gastric cancers. Cancer 65:116–121 [DOI] [PubMed] [Google Scholar]
- Oota K, Sobin LH (1977) Histological typing of gastric and oesophageal tumors. World Health Organization, Geneva [Google Scholar]
- Pihl E, Malahy MA, Khankhanian N, Hersh EM, Maviligit GM (1977) Immunomorphological features of prognostic significance in Dukes' class B colorectal carcinoma. Cancer 37:4145–4149 [PubMed] [Google Scholar]
- Ribeiro MM, Seoxas M, Sobrinho-Simoes M (1988) Prognosis in gastric carcinoma. The preeminence of staging and futility of histological classification. Dig Dis Pathol 1:51–68 [Google Scholar]
- Rohde H, Gebbensleben B, Bauer P, Stützer H, Zieschang J (1989) Staging gastric cancer: is there any improvement? Cancer 64:2465–2481 [DOI] [PubMed] [Google Scholar]
- Roitt I, Brostoff J, Male D (1985) Immunology. Churchill Livingstone, Edinburgh [Google Scholar]
- Sasse W, Heinicke A (1985) Lebenserwartung nach kurativer und palliativer Magenresektion. In: Bünte H, Langhans P, Meyer H-J, Pichlmayr R (eds) Aktuelle Therapie des Magenkarzinoms. Springer, Berlin Heidelberg New York [Google Scholar]
- Schmitz-Moormann P, Pohl C, Himmelmann GW, Neumann K (1986) Morphological predictors of survival in advanced gastric carcinoma. Univariate and multivariate analysis. J Cancer Res Clin Oncol 112:156–164 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schmitz-Moormann P, Himmelmann GW, Baum U, Nilles M (1987) Morphological predictors of survival in colorectal carcinoma: univariate and multivariate analysis. J Cancer Res Clin Oncol 113:586–592 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thompsen PG (1973) Relationship of lymphocytic infiltration to prognosis in primary malignant melanoma of the skin. Pigment cells 1:285–291 [Google Scholar]
- Vorlaender K-O (ed) Immunologie. Grundlagen-Klinik-Praxis. Thieme, Stuttgart
