title: Surgical treatment results of intestinal and diffuse type gastric cancer. Implications for a differentiated therapeutic approach?
abstract: OBJECTIVE
  To study the outcome of patients who were surgically treated for primary gastric cancer with specific attention to differences in treatment results for intestinal and diffuse type tumours.
  
  
  METHODS
  All patients who underwent a potentially curative gastric resection between 1995 and 2011 in our institute were included. Patient, tumour and treatment characteristics were obtained retrospectively. Binary logistic and Cox regression models were used for multivariate analysis.
  
  
  RESULTS
  A consecutive series of 132 patients was included. Median follow-up was 53 months. There were no significant differences between patients with intestinal (N = 62) versus diffuse type (N = 70) gastric cancer with regard to the proportion of patients who underwent (neo)adjuvant treatment. Postoperative mortality was 2%. Pathological T- and N-stage were significantly more advanced for patients with diffuse type tumours. There was a significant difference in the percentage of microscopically irradical resections (2% versus 24%, p < 0.001) and median overall survival (129 versus 17 months, p < 0.001) between patients with intestinal type tumours and those with diffuse type tumours. On multivariate analysis, diffuse type histology was the only factor significantly associated with an R1 resection. In a multivariate Cox regression model, diffuse type histology was a significant adverse prognostic factor for overall survival.
  
  
  CONCLUSIONS
  Striking differences were found between patients with diffuse type tumours and those with intestinal type tumours. These differences call for a differentiated approach in the potentially curative treatment of these two tumour types.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. j.stiekema@nki.nl
authors.forename: J
authors.initials: J
authors.lastname: Stiekema
authors.forename: A
authors.initials: A
authors.lastname: Cats
authors.forename: A
authors.initials: A
authors.lastname: Kuijpers
authors.forename: F
authors.initials: F
authors.lastname: van Coevorden
authors.forename: H
authors.initials: H
authors.lastname: Boot
authors.forename: E P M
authors.initials: EP
authors.lastname: Jansen
authors.forename: M
authors.initials: M
authors.lastname: Verheij
authors.forename: O
authors.initials: O
authors.lastname: Balague Ponz
authors.forename: M
authors.initials: M
authors.lastname: Hauptmann
authors.forename: J W
authors.initials: JW
authors.lastname: van Sandick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D009426:Netherlands; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome