Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1162
Peer-review started: December 30, 2021
First decision: March 13, 2022
Revised: April 1, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: June 15, 2022
Processing time: 161 Days and 15.1 Hours
In the molecular era, the Laurén system is still a cost-effective and widely implemented classification for gastric cancer (GC) and it has been recently associated with clinical, histological and molecular features of these tumors. Laurén subtypes have also shown differences in response to systemic therapy.
Despite recent advances in the understanding of the molecular biology of GC, there is a need to develop new prognostic tools for patient stratification in clinical practice. The implementation of specific scores for patients with intestinal and diffuse-type GC may significantly improve risk assessment and management of GC.
Our aims were to: (1) evaluate the clinicopathological differences between Laurén subtypes; (2) identify specific risk factors for these subtypes; and (3) develop prognostic scores for patients with intestinal and diffuse-type GC.
This is a retrospective study of all patients undergoing surgery for GC at a tertiary referral center from 2001 to 2019. Clinical data and gross findings were collected. Histological and immunohistochemical features were assessed by two independent pathologists and prognostic scores were developed based on hazard ratios.
In our series of western patients with GC, intestinal and diffuse-type tumors showed distinctive epidemiological, clinical and prognostic features. In addition, Laurén subtypes were associated with different risk factors for tumor progression and cancer-specific death. Our prognostic scores for predicting overall survival and disease-free survival in patients with intestinal and diffuse-type GC included clinicopathological variables that can be easily calculated in clinical practice and showed an excellent patient stratification into three (diffuse GC) or four (intestinal GC) prognostic groups.
The stratification of GC patients depending on Laurén subtypes and the implementation of specific clinicopathological prognostic scores in intestinal and diffuse-type tumors can be useful for patient stratification, risk assessment and treatment selection.
Our prognostic scores should be externally validated in patients from both western and eastern countries due to the geographical variation of GC. In addition, this study opens a door to the development and implementation of cost-effective and specific clinicopathological prognostic scores in patients with GC in different contexts.