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. 2022 Jun;29(6):3911-3920.
doi: 10.1245/s10434-021-11252-y. Epub 2022 Jan 18.

Clinical Relevance of the Tumor Location-Modified Laurén Classification System for Gastric Cancer in a Western Population

J L Moore  1   2 , A R Davies  3   4 , A Santaolalla  4   5 , M Van Hemelrijck  4   5 , N Maisey  6 , J Lagergren  3   4   7 , J A Gossage  3   4 , M Kelly  3   4 , C R Baker  3   4 ; Guy’s and St. Thomas’ Esophago-gastric Research Group
Collaborators, Affiliations

Clinical Relevance of the Tumor Location-Modified Laurén Classification System for Gastric Cancer in a Western Population

J L Moore et al. Ann Surg Oncol. 2022 Jun.

Abstract

Background: The Tumor Location-Modified Laurén Classification (MLC) system combines Laurén histologic subtype and anatomic tumor location. It divides gastric tumors into proximal non-diffuse (PND), distal non-diffuse (DND), and diffuse (D) types. The optimum classification of patients with Laurén mixed tumors in this system is not clear due to its grouping with both diffuse and non-diffuse types in previous studies. The clinical relevance of the MLC in a Western population has not been examined.

Methods: A cohort study investigated 404 patients who underwent gastrectomy for gastric adenocarcinoma between 2005 and 2020. The classification of Laurén mixed tumors was evaluated using receiver operating characteristic (ROC) curve analysis and comparison of clinicopathologic characteristics (chi-square). Survival analysis was performed using multivariable Cox regression.

Results: The ROC curve analysis demonstrated a slightly higher area under the curve value for predicting survival when Laurén mixed tumors were grouped with intestinal-type rather than diffuse-type tumors (0.58 vs 0.57). Survival, tumor recurrence, and resection margin positivity in mixed tumors also was more similar to intestinal type. Distal non-diffuse tumors had the best 5-year survival (DND 64.7 % vs PND 56.1 % vs diffuse 45.1 %; p = 0.006) and were least likely to have recurrence (DND 27.0 % vs PND 34.3 % vs diffuse 48.3 %; p = 0.001). Multivariable analysis demonstrated that MLC was an independent prognostic factor for survival (PND: hazard ratio [HR], 1.64; 95 % confidence interval [CI], 1.16-2.32 vs diffuse: HR, 2.20; 95 % CI, 1.56-3.09) CONCLUSIONS: The MLC was an independent prognostic marker in this Western cohort of patients with gastric adenocarcinoma. The patients with PND and D tumors had worse survival than those with DND tumors.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier survival analysis of the Laurén classification for a overall survival and b disease-free survival. The significance of the difference between survival curves was calculated using the log-rank test
Fig. 2
Fig. 2
Kaplan-Meier survival analysis of the Tumor Location-Modified Laurén Classification (MLC) for a overall survival and b disease-free survival. The significance of the difference between survival curves was calculated using the log-rank test
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curve analysis for overall survival. Comparison of all variables is listed in order of positive predictive ability
See this image and copyright information in PMC

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