A new histological classification and grading-score system of gastric cancer

Purpose To put forward a new histological classification and grading-score system for evaluating the biological behavior and prognosis of gastric cancer.Methods Based on the high heterogeneous histological characteristics and WHO classification,TNM classification,and the histological and molecular findings of histological differentiation and biological behavior of gastric carcinoma,a new histological type and grading-score system of gastric cancer has been presented.In this system,histological types included no-mucous-producing adenocarcinoma(papillary adenocarcinoma,well-differentiated,moderately-differentiated,or poorly-differentiated tubular adenocarcinoma),mucous-producing carcinomas(mucous adenocarcinoma and signet ring cell carcinoma),undifferentiated carcinoma and special type gastric cancer.The histological grade of no-mucous-producing adenocarcinoma was 1~3 scores and that of mucous-producing carcinomas was 3 and 4 scores in turn.The histological grade of undifferentiated carcinoma was 5 scores,and that of special type gastric cancer was 4 scores,respectively.Then,according to the percentage of different histological structure area in the total areas of gastric carcinoma,which was divided into the most common tumor pattern(primary area,main type) and second common tumor pattern(secondary area,minor type).The pathologist assigned a grade to the most common tumor pattern,and a second grade to the next most common tumor pattern.Finally the two grades are added together to get a total score of gastric cancer.This grading-score system had been used to evaluate 216 pathological specimens of advanced gastric cancer and to analyze the relationship with TNM staging.Results The results showed that there was a close relation between the grading-score and TNM staging(P0.05).While the rising of gastric cancer histological grading score,the TNM staging also increased synchronously.Conclusion This grading-score system of gastric cancer provides a new strategy and parameter for evaluating the biological behavior and prognosis of gastric cancer.Although the system also needs to be corrected and updated in future by the multi-center prospective study of large-sample testing,it is still expected to become a new reliable indicator for evaluating the biological behavior and prognosis of gastric cancer.