GOSEKI HISTOLOGICAL GRADING OF GASTRIC-CANCER IS AN IMPORTANT PREDICTOR OF OUTCOME

TNM (tumour, node, metastases) staging has thus far been the most impo rtant guide to prognosis in patients with gastric cancer. Histological grading, in contrast, has not provided any additional information. Re cently a novel grading System based on tubular differentiation and muc us production has proposed, which was correlated patterns of tumour sp read found at necropsy. This study set out to assess its value as a de terminant of survival after gastric resection. In a consecutive series of 211 patients who had potentially curative resection for gastric ca ncer, five histological grading systems assessed: the Lauren type, the type, degree of differentiation, the type of tumour border, and the l ymphocytic response to the tumour and compared with the Goseki grading (I-IV). When T and N stage were taken into account, using Cox's propo rtional hazards model, only the Goseki grading added further to the ab ility to predict survival. The proportional hazards ratios were: node negative v node positive 6.5 T1 v T3 2.45; Goseki I v Goseki IV 3.1. F ive year survival of patients with mucus (Goseki II and IV) T3 tumours was significantly worse than that of patients with mucus poor (Goseki I and III) T3 tumours (18% v 53%, p < 0.003). Goseki grading identifi es subgroups of patients with a poorer prognosis than is predicted by TNM staging alone. It could prove useful in the selection of patients for adjuvant therapy after potentially curative resection for gastric cancer.