[Clinicopathologic features of gastric adenocarcinoma based on the revised Lauren's classification].

Objective: To compare the clinicopathologic features and prognosis of the subtypes in a consecutive series of gastric cancers (GC) patients basing on the revised Lauren's classification so as to better understand the biological behavior of GC. Methods: The surgically resected GC from Peking Union Medical College Hospital during 2003-2005 were reviewed for patients' age, gender, tumor size, location, Borrman classification, depth of invasion, lymph node metastasis, vascular invasion, and tumor growth pattern (Ming classification). Results: One hundred and sixty-six GC cases were enrolled and classified into four groups: intestinal GC (30, 18.1%), diffuse GC (56, 33.7%), solid GC (9, 5.4%), and mixed GC (71, 42.8%). Intestinal GC patients were older[ (63.2±11.3) years], with a male predominance, and were more frequently found in the antrum. Intestinal GC was the most common subtype for early GC, and tend to develop liver metastases. Diffuse GC patients were youngest [(52.2±12.7) years], with no gender difference, and were usually found in the antrum. Microscopically, diffuse GC were more likely infiltrative (51/56, 91.1%), and tended to metastasize by lymphatic pathway. Solid GC were usually large[ (6.4±2.2) cm], with a male predominance, and the most frequent site was the body/fundus. Solid GC were more likely to show expansile growth pattern with greater depth of invasion (8 of 9 cases were T3/4), but lower rate of lymphatic metastasis. Mixed GC also showed a male predominance, usually found in the antrum, and showed an infiltrative growth pattern (49/71, 69.0%). Though there was fewer T3/4 than solid and diffuse GC, mixed GC were more likely to show lymph nodes, vascular metastases and liver metastases (13/71, 18.3%). TNM staging, lymph nodes metastasis, lymphovascular invasion and revised Lauren's classification were four independent prognostic factors on multivariate analysis(P<0.05). The survival of patients with mixed GC were significantly worse than patients with other histological types. Conclusion: Revised Lauren's classification for GC has four distinct subgroups and can be used as independent prognostic factors.目的： 分析修订版Lauren分型各亚型临床病理学特征及预后，为更好地认识胃癌及其生物学行为积累经验。 方法： 回顾性分析北京协和医院2003至2005年根治性胃癌切除病例，比较修订版Lauren分型各亚型患者的年龄、性别、肿瘤大小、部位、Borrman分型、浸润深度、淋巴结转移、脉管侵犯、肿瘤生长方式(Ming分型)。 结果： 入组胃癌166例，根据修订版Lauren分型分为4组。肠型30例(18.1%)，弥漫型56例(33.7%)，实性型9例(5.4%)和混合型71例(42.8%)。肠型患者年龄偏大，平均(63.2±11.3)岁，男性好发，胃窦部多见，是早期胃癌最常见的亚型，易肝转移。弥漫型患者年龄较轻，平均(52.2±12.7)岁，无性别差异，胃窦部多见，镜下以浸润性生长为主(91.1%，51/56)，易淋巴道转移。实性型肿瘤较大，平均(6.4±2.2)cm，男性好发，多见于胃底/体，膨胀性生长，常浸润较深，T3/4比例高(8/9)，但淋巴结转移率低。混合型男性好发，胃窦多见，以浸润性生长为主(69.0%，49/71)，T3/4比例低于实性型和弥漫型，但易淋巴道及血道转移，18.3%(13/71)有肝转移。多因素分析显示肿瘤分期、淋巴结转移、脉管瘤栓和修订版Lauren分型是胃癌的独立预后因素(P<0.05)，实性型胃癌生存率最高，混合型胃癌生存率最低。 结论： 修订版Lauren分型的4种亚型具有不同的临床病理学特征及预后，是胃癌的独立预后因素。.