| Objective:To discuss the role of Lauren classification in gastric cancerpathology classification. To explore the clinical signification of endoscopicbiopsy in the preoperative Lauren classification of gastric cancer. To comparethe advantages and disadvantages of Lauren classification and WHOclassification. This paper summarized the clinical and pathologicalcharacteristics of different pathological type of gastric cancer.Methods:Collect the pathological section of gastric cancer (including160cases of endoscopic specimens and487cases of gross pathologic specimens)diagnosed by the second hospital of jilin university during2011.1to2013.10.Divide them into intestinal type, diffuse type and mixed typeaccording to the Lauren criteria. Then divide them into well-differentiatedadenocarcinomas, moderately differentiated adenocarcinoma, poorlydifferentiated adenocarcinoma signet ring cell carcinoma and mucousadenocarcinoma according to the WHO criteria. Different pathological type ofgastric cancer were retrospectively analyzed the gender, age, T stage, N stage,the expression of Ki67/CDX2/P53/EGFR/VEGF/Her-2, the level ofCEA/CA199in serum and hemoglobin levels, etc.160patients withgastroscope biopsy specimens were contrasted with the same postoperativepathologic specimens, comparing the accuracy of gastroscope biopsy in Laurenclassification preoperative diagnosis of gastric cancer. Enumeration data wasprocessed by chi-square test. Measurement data obeying normal distributionwas processed by T test, not obeying by rank sum test. Coincidence ratecomparation between the two groups was processed by Kappa test.Result:Frist of all, claify these pathological sections into intestinal type,diffuse type and mixed type gastric cancer according to Lauren classification standard. The results showed:①Incidence of male were higher than femaleamong three kinds of pathological type of gastric cancer, and male incidence ofgastric cancer was significantly higher in mixed type than diffuse type gastriccancer, the disparity was statistically significant (P<0.05). The average age ofintestinal type of gastric cancer was64.26±9.69years,58.72±11.48years ofdiffuse gastric cancer and63.33±8.26years of mixed type gastric cancer.Diffuse type gastric cancer was obviously younger than that of intestinal typeand mixed type gastric cancer, the disparity was statistically significant(P<0.05). The disparity in tumor infiltration depth and number of lymph nodemetastasis had no difference in three kinds of pathological type of gastriccancer.②The positive percentage of Ki67in intestinal type of gastric cancerwas55.95%±20.37%,45.50%±21.74%in diffuse type gastric cancer and47.08%±21.37%in mixed type gastric cancer. Intestinal type gastric cancerKi67positive percentage was significantly higher than diffuse type gastriccancer (P<0.05). CDX2positive expression rate was80.49%in intestinal typegastric cancer,50.85%in diffuse gastric cancer and66.67%in mixed typegastric cancer. The expression rate of CDX2was obviously higher in intestinaltype gastric cancer than diffuse gastric cancer, the difference was statisticallysignificant (P<0.01). The expression of EGFR, P53, VEGF and Her-2in threetypes of gastric cancer had no statistically significant difference.③The serumCA199level of intestinal type gastric cancer was obviously higher than that ofdiffuse gastric cancer, had significant difference(P<0.05). There was nosignificant difference about CEA levels among different types of gastric cancer.④The degree of anemia in three kinds of gastric cancer was no significantdifference.⑤The gastroscope biopsy of gastric cancer Lauren classification ofpreoperative diagnosis coincidence rate was79.38%(K=0.591). Secondly,claify these pathological sections into well differentiated adenocarcinoma,moderately differentiated adenocarcinoma, poorly differentiated adenocarcinoma,signet ring cell carcinoma and mucous adenocarcinomaaccording to the WHO classification standards.The results showed:①Themean age of well-differentiated adenocarcinomas was64.42±10.57years,63.43±9.61years of moderately differentiated adenocarcinoma,62.34±10.90years of poorly differentiated adenocarcinoma,56.28±10.92years of signetring cell carcinoma and64.23±8.66years of mucous adenocarcinoma. Signetring cell carcinoma was younger than the other four kinds of pathological typeof gastric cancer, and statistical analysis of difference was significant (P<0.01).Infiltration depth of well-differentiated adenocarcinoma was shallower thanpoorly differentiated adenocarcinoma and signet ring cell carcinoma, and thedifference was statistically significant(P<0.05).On the numbers of lymph nodemetastasis, well-differentiated adenocarcinomas was less than poorlydifferentiated adenocarcinoma and signet ring cell carcinoma, the differencewas statistically significant(P<0.05).Lymph node metastasis number ofmoderately differentiated adenocarcinoma was less than poorly differentiatedadenocarcinoma, with significant difference (P<0.01).There was no significantdifference about sex ratio among these five kinds of pathological type gastriccancers.②The positive percentage of Ki67in well-differentiatedadenocarcinomas was52.00%±25.88%,49.50%±18.77%in moderatelydifferentiated adenocarcinoma,53.57%±18.98%in poorly differentiatedadenocarcinoma,and38.57%±20.32%in signet ring cell carcinoma. Ki67positive percentage of poorly differentiated adenocarcinoma was obviouslyhigher than that of signet ring cell carcinoma, with significantdifference(P<0.05). The VEGF positive expression rate of well-differentiatedadenocarcinomas was100%,80.95%in moderately differentiatedadenocarcinoma,100%in poorly differentiated adenocarcinoma, and89.29%in signet ring cell carcinoma. VEGF positive expression rate was obviouslyhigher in poorly differentiated adenocarcinoma than moderately differentiated adenocarcinoma and signet ring cell carcinoma, the difference was statisticallysignificant (P<0.05). The positive expression rate of Her-2was obviouslyhigher in well-differentiated adenocarcinoma than that of poorly differentiatedadenocarcinoma and signet ring cell carcinoma, and the difference wassignificant(P<0.01).The expression of EGFR, P53and CDX2had nostatistically significant difference in different pathological type of gastriccancer.③The serum CA199level of well-differentiated adenocarcinomas wasobviously higher than that of signet ring cell carcinoma, and the difference wassignificant(P<0.01). There was no significant difference about CEA levelsamong different types of gastric cancer.④There was no statistically significantdifference about degree of anemia in different pathological type of gastriccancer.Conclusion:①Lauren classification standard is simple and clear, and canreflect more about sex ratio and age distribution of gastric cancer.②Differentexpression of Ki67and CDX2in various pathological types of Laurenclassification provides a basis for individualized treatment of different types ofgastric cancer.③The serum CA199level in various pathological types ofLauren classification system is different, which plays an important role in earlydiagnosis.④The WHO classification and grading standard is complex, whichhas advantages in tumor infiltration depth and lymph node metastasis. But thediversity about expression of immunehistochemical enzyme marks and thelevel of serum tumor markers is equal between the two system.⑤Gastroscopebiopsy has an important clinical value in preoperative diagnosis about Laurenclassification of gastric cancer.⑥Lauren classification plays an important rolein the pathological diagnosis of gastric cancer. |
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