Adenocarcinoma with Mixed Subtypes in the Early and Advanced Gastric Cancer.

Xixian Zhao,Hailin Zhang,Yizhang Li,Jing Liu,Jun Lin,Hongling Wang,Zhenwei Yang,Qiu Zhao,Ravindran Caspa Gokulan

doi:10.1155/2021/8497305

Abstract

Objective Adenocarcinoma with mixed subtypes (AM) is a histological classification based on the WHO classification. We aimed to compare the prognosis among AM, classic adenocarcinoma (CA), mucinous adenocarcinoma (MAC), and signet-ring cell carcinoma (SRCC) in early and advanced gastric cancer (EGC and AGC), respectively. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried from 2001 to 2016. Univariate and multivariate Cox analyses were performed to compare prognosis between AM and histologic subtypes of CA, SRCC, and MAC in ECG and ACG. A nomogram was established to predict the cancer-specific survival (CSS) of gastric cancer (GC) patients with AM. C-index, calibration curves, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were applied to examine the accuracy and clinical benefits. Results In the prognosis among these four histological subtypes in EGC patients, there are no differences. For AGC patients, AM had a significantly poorer prognosis compared with CA and MAC (P=0.003, 0.029) but similar prognosis to SRCC. A nomogram based on race, T stage, N stage, M stage, and surgical modalities was proposed to predict 1- and 3-year CSS for GC patients with AM (C-index: training cohort: 0.804, validation cohort: 0.748. 1- and 3-year CSS AUC: training cohort: 0.871 and 0.914, validation cohort: 0.810 and 0.798). 1- and 3-year CSS DCA curves showed good net benefits. Conclusions EGC patients with AM had similar survival to those with CA, MAC, and SRCC. AM was an independent predictor of poor prognosis in AGC. A nomogram for predicting the prognosis of GC patients with AM was proposed to quantitatively assess the long-term survival.

Highlights

More than one million (1,033,701) new cases of gastric cancer (GC) were diagnosed globally in 2018, with 782,685 deaths [1]. 90% of gastric cancer is adenocarcinomas (ACs) [2]. ere were multiple studies on the prognosis of GC patients with the histology of mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRCC) [3,4,5,6,7]
Adenocarcinoma with mixed subtypes (AM) is a type of uncommon adenocarcinoma in GC based on WHO classification, which is defined as morphologically a combination of identifiable glandular and signet-ring/poorly cohesive cellular components [9]
Incidence Trends. e number of newly diagnosed GC patients with AM from 2001 to 2016 was divided by age, and the most common age at diagnosis was 72–74 years (Figure 1(a)). e trend from 2001 to 2016 in age-adjusted incidence for GC patients with AM was illustrated with an Annual percentage changes (APCs) of 3.7% (Figure 1(b)). e mortality rate increased from 2001 to 2012 with an APC of 5.1% but decreased from 2012 to 2016 with an APC of −28.1% (Figure 1(b))

Summary

Introduction

More than one million (1,033,701) new cases of gastric cancer (GC) were diagnosed globally in 2018, with 782,685 deaths [1]. 90% of gastric cancer is adenocarcinomas (ACs) [2]. ere were multiple studies on the prognosis of GC patients with the histology of mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRCC) [3,4,5,6,7]. Ere were multiple studies on the prognosis of GC patients with the histology of mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRCC) [3,4,5,6,7]. Clinical features and prognosis of SRCC were reported to be different between early gastric cancer and advanced gastric cancer (EGC and AGC) [8]. Ere may still be other histologic subtypes with distinct clinicopathologic characteristics and prognosis that need special concern in clinical management. Ere is no report on the comparison of prognosis among AM, classic adenocarcinoma (CA), MAC, and SRCC in EGC and AGC, respectively. We compared the prognosis among EGC and AGC patients with AM and other histologic subtypes of CA, MAC, and SRCC based on Surveillance, Epidemiology, and End Results (SEER) database. We developed a predictive nomogram to quantify the survival estimates of GC patients with AM.

Methods

Results

Discussion

Conclusion