| Underground Gastric cancer is one of the common malignant tumors in China,and adenocarcinoma is a common pathological type in gastric cancer.Surgery,chemotherapy,radiotherapy,molecularly targeted therapy and immunotherapy have become the main treatments for gastric adenocarcinoma.Lauren classification is currently the most commonly used pathological typing method for gastric adenocarcinoma.According to its classification,gastric cancer is classified into three categories: intestinal type,diffuse type and mixed subtype.The etiology,epidemiology,clinical presentation,and pathological features differ in GC with different Lauren types.Especially in terms of molecular phenotype,human epidermal growth factor receptor 2(HER-2),programmed death receptor ligand 1(PD-L1),microsatellite instability(MSI),vascular endothelial growth factor(VEGF)and CDH 1 gene are closely related to gastric cancer with different Lauren classification.Recently,the systemic treatment of gastric cancer has developed rapidly.In this study,we analyzed the relationship between etiology specificity and prognosis in patients with gastric adenocarcinoma with Lauren classification after preoperative treatment,which could provide evidence for treatment decision making and follow-up strategies of gastric adenocarcinoma of different histological types.Method This study used a retrospective cohort study to retrieve all patients with gastric adenocarcinoma from the SEER database by using SEER * Stat software(version8.4.0.1).The main outcome measures were total survival and cancer-specific survival.To eliminate confounding factors.Then,we matched the two groups of patients in a ratio of 1:1.Then the patients were divided into two groups according to intestinal type and diffusion type,and Pearson chi-square test was used to investigate their correlation with classification variables.When analyzing clinical data in different histological types,chi-square test was used for unordered classification variables,and rank sum test was used for ordered classification variables.Kaplan-Meier method was used to analyze the survival and calculate the disease-specific survival rate.Log-rank test was used to compare the survival rate.Based on the results,a multifactor COX risk regression model was established to determine the factors affecting the survival of patients.Finally,subgroup analysis was performed.P<0.05 is statistically significant.Result Research data and objects A total of 5736 Lauren classified gastric adenocarcinoma patients were enrolled in the final pairing,and the clinical and pathological features in the selected data were comparable and balanced.Analysis of survival and prognostic factors The median survival period of 5736 Lauren classified gastric adenocarcinoma patients was 22 months(95% CI: 20.894-23.106 months),and the median tumor specific survival period was 24 months(95% CI: 22.667-25.333months).Among them,the 1-year,3-year,and 5-year cumulative survival rates were61.47%,24.53%,and 12.83%,respectively.The Kaplan Meier curve results showed that patients with intestinal gastric adenocarcinoma had better overall survival and tumor specific survival compared to patients with diffuse gastric adenocarcinoma(OS:P<0.001;CSS: P<0.001);The overall survival and tumor specific survival of gastric cancer patients receiving preoperative systemic treatment were better than those without preoperative systemic treatment(OS: P<0.001;CSS: P<0.001);In patients with intestinal and diffuse gastric cancer,overall survival and tumor specific survival after preoperative systemic treatment showed survival benefits in both groups.Log rank univariate analysis showed that age(P<0.001),race(P<0.001),year of diagnosis(P<0.001),primary site(P<0.001),AJCC stage(P<0.001),T stage(P<0.001),N stage(P<0.001),radiotherapy(P<0.001),chemotherapy(P<0.001),preoperative systemic treatment(P<0.001),and Lauren classification(P<0.001)were prognostic factors affecting gastric adenocarcinoma.Among them,age>60 years old,Indian and other ethnic groups,gastric overlapping lesions,stage III,T4,N3,and diffuse gastric adenocarcinoma have a short median survival time and poor prognosis.The results of COX multivariate regression analysis showed that patients elder than 60 years had a higher risk of death compared to those aged<60 [P<0.001,β= 0.237,HR(95% CI):1.268(1.180-1.361)];Asians or Pacific Islanders have a lower risk of death than whites[P<0.001,β=-0.321,HR(95% CI): 0.725(0.664-0.793)],American Indians/Alaska Natives have a higher death risk than whites [P<0.001,β =-0.717,HR(95% CI):2.049(1.550-2.709)];Gastric fundus [P<0.001,β =-0.378,HR(95% CI): 0.679(0.550-0.839),gastric body [P<0.001,β=-0.511,HR(95% CI): 0.600(0.523-0.688),gastric antrum [P<0.001,β =-0.403,HR(95% CI): 0.668(0.598-0.747),pylorus[P<0.001,β=-0.509,HR(95% CI): 0.601(0.493-0.733),gastric curvature [P<0.001,β =-0.503,HR(95% CI): 0.604(0.527-0.693),greater curvature of the stomach[P<0.001,β =-0.532,HR(95% CI): 0.587(0.485-0.711),gastric overlap lesion[P=0.013,β=-0.162,HR(95% CI): 0.850(0.748-0.966)] The risk of death is lower than that of the cardia;The risk of death in stage III is higher than that in stage II[P<0.001,β= 0.398,HR(95% CI): 1.489(1.318-1.683)];T4 phase [P=0.004,β=0.362,HR(95% CI): 1.436(1.119-1.844),T3 phase [P<0.001,β= 0.635,HR(95% CI):1.887(1.449-2.457)] has a higher risk of death than T1;N1 phase [P<0.001,β= 0.086,HR(95% CI): 1.090(0.976-1.217),N3 phase [P<0.001,β = 0.102,HR(95% CI):1.107(0.968-1.266)] has a higher risk of death compared to N0,N2 [P<0.001,β=-0.163,HR(95% CI): 0.850(0.740-0.975)] has a lower risk of death compared to N0;Not receiving chemotherapy [P<0.001,β= 0.513,HR(95% CI): 1.671(1.534-1.821),radiotherapy [P<0.001,β= 0.231,HR(95% CI): 1.260(1.1651.363)] or preoperative systemic treatment [P<0.001,β = Patients with 0.564,HR(95% CI): 1.758(1.606-1.363)had a higher risk of death compared to those receiving the aforementioned treatment;Patients with diffuse gastric cancer [P<0.001,β = 0.205,HR(95% CI): 1.227(1.149-1.311)] has a high risk of death.And it was found that age,race,primary site,AJCC stage,T stage,N stage,chemotherapy,radiotherapy,preoperative systemic treatment,and Lauren’s classification all had P values less than0.001,which are independent factors affecting the prognosis of Lauren’s classification of gastric adenocarcinoma patients.Subgroup analysis showed that patients with intestinal gastric adenocarcinoma had better survival time than those with diffuse gastric adenocarcinoma when they were elder than 60 years old(P<0.001),white(P<0.001),cardiac cancer(P=0.006),gastric overlapping lesions(P=0.006),stage II(P<0.001),stage III(P<0.001),stage T3(P<0.001),stage T4(P=0.005),stage N0(P<0.001),stage N1(P=0.002),and stage N2(P=0.032),regardless of whether they underwent chemotherapy The survival time of patients with intestinal gastric cancer is better than that of patients with diffuse gastric adenocarcinoma through radiotherapy and preoperative systemic treatment.Summary This study collected SEER database data and conducted statistical analysis on it.Among them,survival analysis showed that patients with intestinal gastric adenocarcinoma had better overall survival and tumor specific survival compared to patients with diffuse gastric adenocarcinoma;The overall survival and tumor specific survival of gastric cancer patients undergoing preoperative systemic treatment were better than those without preoperative systemic treatment;In patients with intestinal and diffuse gastric cancer,overall survival and tumor specific survival after preoperative systemic treatment showed survival benefits in both groups,indicating that preoperative systemic treatment had significant survival benefits for both intestinal and diffuse gastric cancer patients.Log-rank univariate analysis showed that age,race,year of diagnosis,primary site,AJCC stage,T stage,N stage,radiotherapy,chemotherapy,preoperative systemic treatment,and Lauren’s classification were prognostic factors affecting of gastric adenocarcinoma patients;COX multivariate regression analysis showed that patients aged elder than 60 years had a higher risk of death compared to those aged<60;Asians or Pacific Islanders have a lower risk of death than whites,and American Indians/Alaska Natives have a higher risk of death than whites;The risk of death from gastric fundus,gastric body,gastric antrum,pylorus,lesser curvature,greater curvature,and overlapping gastric lesions is lower than that of the cardia;The risk of death in stage III is higher than that in stage II;The risk of death in T4 and T3 stages is higher than that in T1 stage;The risk of death in N1 and N3 phases is higher than that in N0 phase,while the risk of death in N2 phase is lower than that in N0 phase;Patients who did not receive chemotherapy,radiation therapy,or preoperative systemic treatment had a higher risk of death compared to those who received the aforementioned treatment;Patients with diffuse gastric cancer have a high risk of death.And it was found that age,race,primary site,AJCC stage,T stage,N stage,chemotherapy,radiotherapy,preoperative systemic therapy,and Lauren’s classification are independent prognostic factors for gastric cancer patients;Subgroup analysis showed that patients with intestinal gastric adenocarcinoma had better survival time than those with diffuse gastric adenocarcinoma when they were elder than 60 years old,white,cardiac cancer,gastric overlapping lesions,stage II,III,T3,T4,N0,N1,N2,etc.Regardless of whether they underwent chemotherapy,radiotherapy,or preoperative systemic treatment,intestinal gastric cancer patients had better survival time than those with diffuse gastric adenocarcinoma,The treatment of patients with diffuse gastric adenocarcinoma may need to be strengthened in the above situations,but specific clinical decisions need to be individualized based on the patient’s condition.Due to some limitations in this article,there may be confounding bias that is difficult to exclude,and more clinical studies are needed to verify the specific analysis. |
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