Histological Grading in Gastric Cancer by Ming Classification: Correlation with Histopathological Subtypes, Metastasis, and Prognosis |
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Authors: | Thomas Luebke MD Stephan E Baldus MD Guido Grass MD Elfriede Bollschweiler MD Jürgen Thiele MD Hans-Peter Dienes MD Arnulf H Hoelscher MD Stefan P Moenig MD |
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Institution: | Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, Cologne 50931, Germany. |
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Abstract: | The aim of this prospective study was to analyze Ming’s classification in correlation with other currently used classification
systems of gastric cancer. In addition, we wanted to define the prognostic significance of the Ming classification system.
The present study analyzed material of 117 patients with gastric carcinoma who underwent D2-gastrectomy with curative intent.
All specimens were catagorized according to International Union Against Cancer (UICC) classification, World Health Organization
(WHO) classification, Borrmann classification, Laurén classification, Goseki classification, Ming classification, and tumor
differentiation. For analysis of correlation between the classification systems, the correlation coefficient according to
Spearman was calculated. The survival curves have been calculated according to the Kaplan-Meier method. According to the Ming
classification, 38.5% of the carcinomas exhibited an expanding growth pattern, and 61.5% of specimens showed an infiltrating
growth pattern. The subtypes according to the Ming and Laurén classification correlated significantly (P < 0.001). WHO classification (P < 0.001), tumor differentiation (P < 0.001), and Goseki classification (P < 0.001), as well as the macroscopic classification of Borrmann (P < 0.001) and the pT and pN categories of the UICC classification exhibited a highly significant correlation with the Ming
classification (P < 0.001 and 0.001, respectively). Median overall survival was 31.3 months. In Kaplan-Meier analysis, the 3-year survival
rates were lower in the infiltrative tumor type when compared to the expansive tumor type according to Ming (P = 0.0847). In multivariate analysis, only the UICC system presented as an independent prognostic factor in multivariate analysis
(P < 0.001). This study shows that the Ming classification correlates significantly with the currently used classification systems
for gastric cancer and with the UICC staging system, especially, the pT and pN category. The 3-year survival rates were lower
in the infiltrative tumor type than in the expansive tumor type according to Ming. However, the Ming classification is not
an independent prognostic factor. |
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