title: Clinical Relevance of the Tumor Location-Modified Lauren Classification System of Gastric Cancer.
abstract: The Lauren classification system is a very commonly used pathological classification system of gastric adenocarcinoma. A recent study proposed that the Lauren classification should be modified to include the anatomical location of the tumor. The resulting three types were found to differ significantly in terms of genomic expression profiles. This retrospective cohort study aimed to evaluate the clinical significance of the modified Lauren classification (MLC).
  
  
  
  A total of 677 consecutive patients who underwent curative gastrectomy from January 2005 to December 2007 for histologically confirmed gastric cancer were included. The patients were divided according to the MLC into proximal non-diffuse (PND), diffuse (D), and distal non-diffuse (DND) type. The groups were compared in terms of clinical features and overall survival. Multivariate analysis served to assess the association between MLC and prognosis.
  
  
  
  Of the 677 patients, 48, 358, and 271 had PND, D, and DND, respectively. Their 5-year overall survival rates were 77.1%, 77.7%, and 90.4%. Compared to D and PND, DND was associated with significantly better overall survival (both P<0.01). Multivariate analysis showed that age, differentiation, lympho-vascular invasion, T and N stage, but not MLC, were independent prognostic factors for overall survival. Multivariate analysis of early gastric cancer patients showed that MLC was an independent prognostic factor for overall survival (odds ratio, 5.946; 95% confidence intervals, 1.524~23.197; P=0.010).
  
  
  
  MLC is prognostic for survival in patients with gastric adenocarcinoma, in early gastric cancer. DND was associated with an improved prognosis compared to PND or D.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jang Kyu
authors.initials: JK
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Son
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyung Ho
authors.initials: HH
authors.lastname: Kim
keywords: Early gastric cancer; Gastric adenocarcinoma; Lauren classification; Modified Lauren classification; Tumor location