"From Lauren's diffuse gastric cancer to WHO's poorly cohesive carcinoma." Clinicopathological and prognostic characteristics.

Ever since Lauren classified gastric cancer into intestinal-type adenocarcinoma and diffuse gastric carcinoma back in 1965 countless categorizations have been published attempting to elucidate the clinicopathological and prognostic differences between histological subtypes. In order to compare subtypes between the most widely used classifications (Lauren and WHO), a retrospective study was undertaken of gastric cancer cases managed in a third-level site over 10 years. A comparative study of the most relevant clinicopathological characteristics and a multivariate survival analysis were carried out. Significant differences exist between histological subtypes in terms of age, gender, location, extension, stage, and received treatment. A univariate overall survival analysis revealed better survival rates for intestinal-type adenocarcinoma as compared to diffuse carcinoma (HR: 1.405 (1.024-1.927)) in Lauren's classification, and a better prognosis of mucinous carcinoma (HR: 0.378 (0.164-0.868)), though failing to prove a poorer prognosis of poorly cohesive (HR: 1.242 (0.878-1.757)) and signet cell (HR: 1.354 (0.792-2.314)) carcinomas, according to the WHO classification. In the multivariate overall survival analysis the following stand out as poor prognosis factors: male gender, local infiltration (T), nodal invasion (N), and received adjuvant therapy. Although the various histological subtypes show significant clinicopathological differences, further studies are needed to compare them and clarify the prognostic relevance of each one.