Differential prognostic implications of gastric adenocarcinoma based on Lauren's classification: a Surveillance, Epidemiology, and End Results (SEER)-based cohort study

Abstract

Background: Our study aims to analyze the association between Lauren's classification and gastric adenocarcinoma prognosis using comprehensive statistical analyses.

Methods: According to the selection criteria, patients were included from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression, propensity score matching, and a multivariate competing risk model were used to investigate the association between Lauren's classification and prognosis. Subgroup analysis was used to investigate the role of confounding factors on the association between Lauren types and prognosis.

Results: After exclusion, a total of 20,218 patients from the SEER database were included, with 14,374 intestinal types and 5,844 diffuse types. The univariate Cox regression analysis revealed that the diffuse type had a poorer cancer-specific survival (CSS) rate [hazard ratio (HR), 1.44; 95% confidence interval (CI), 1.38-1.50]. After adjusting for confounding variables, the diffuse type also showed a higher risk of cancer-specific death (HR, 1.20; 95% CI, 1.15-1.20). Sensitivity analysis showed that after propensity score matching, the diffuse type had a poorer CSS rate (HR, 1.23; 95% CI, 1.10-1.36), and the competing risk model further validated these results [subdistribution HR (SHR), 1.32; 95% CI, 1.23-1.41]. Moreover, subgroup analysis demonstrated stable results in the subgroups, except for patients with T1 stage (HR, 1.06; 95% CI, 0.87-1.28) and a tumor size <2 cm (HR, 1.00; 95% CI, 0.83-1.21).

Conclusions: Diffuse-type gastric adenocarcinoma had an overall poorer prognosis compared to the intestinal type. However, in patients with T1 stage and tumor size <2 cm, the diffuse type had a comparable survival rate with the intestinal type.

Keywords: Gastric adenocarcinoma; Lauren’s classification; Surveillance, Epidemiology, and End Results (SEER); survival.

Figure 1

Flow chart of study participants

Figure 2

Kaplan-Meier analysis of cancer-specific survival based on Lauren’s classification.

Figure 3

Subgroup analyses of the effect of Lauren’s classification on cancer-specific survival. Adjusted, if not be stratified, for age; sex; year; primary site; grade; T stage; N stage; M stage; operation; chemotherapy; tumor size; race; insurance and marital status.

Figure 4

Kaplan-Meier analysis of cancer-specific survival based on Lauren’s classification in subgroups. Kaplan-Meier analysis of cancer-specific survival based on Lauren’s classification in the (A) moderately or well differentiated subgroup; (B) poorly differentiated or undifferentiated subgroup; (C) T1 stage subgroup; (D) T2–TX stage subgroup; (E) M0 stage subgroup; (F) M1–MX stage subgroup; (G) tumor size ≤2 cm subgroup; (H) tumor size >2 cm subgroup.