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A combined histologic and molecular approach identifies three groups of gastric cancer with different prognosis
Virchows Archiv, 08/21/09

Solcia E et al. - In a trial to investigate of histologic, molecular, and clinicopathologic patterns in extensively sampled, invasive gastric cancers representing all main histotypes and stages of the disease, it was shown that the combination of survival-predictive histotypes and individual histologic or molecular parameters allowed the development of a classification of all gastric cancers into 3 grades of increasing malignancy which proved to be of high prognostic value.

Methods

This was an investigation of histologic, molecular, and clinicopathologic patterns in 294 extensively sampled, invasive gastric cancers representing all main histotypes and stages of disease and followed for a median of 150 mos.

Results

Among histologic parameters tested, only cellular atypia, angio-lympho- or neuroinvasion, Ki67 proliferation index, expansile/infiltrative type growth, and T8 cell-rich high lymphoid intra-/peritumor response (HLR) proved to be stage-independent predictors of pt survival.
Among molecular tests, p53 gene exon 7 (loop 3) and 8 (loop-sheet-helix motif and S-10 band), but not p53 protein overexpression, TP53 LOH, or 18qLOH, were found to worsen prognosis.
Microsatellite DNA instability was a favorable prognostic factor when coupled with HLR.
Pt survival analysis of the main histotypes and their subtypes confirmed favorable prognosis of HLR, well-differentiated tubular, muconodular, and low-grade diffuse desmoplastic cancers, and highlighted the worse prognosis of anaplastic and infiltrative-lymphoinvasive mucinous cancers vs ordinary cohesive and diffuse cancers.
Distinct roles of individual morphologic and molecular factors in tumor progression of the different histotypes have been recognized.

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