Prediction of Response and Prognosis by a Score Including only Pretherapeutic Parameters in 410 Neoadjuvant Treated Gastric Cancer Patients

  • Lorenzen Sylvie
  • Blank Susanne
  • Ott Katja
Conference paper
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 196)


Introduction: Response to neoadjuvant chemotherapy (NAC) is an independent prognostic factor in locally advanced gastric cancer. However, no prospectively tested pretherapeutic parameters predicting response and/or survival in gastric cancer are available in clinical routine. Patients and methods: We evaluated the prognostic significance of various clinicopathologic parameters in 410 patients who were treated with NAC followed by gastrectomy. Clinical and histopathological response evaluation was performed using standardized criteria. A prognostic score was created on the basis of the variables identified in the multivariate analysis. Results: Multivariate analysis identified three pretherapeutic parameters as positive predictive factors for response and prognosis: tumor localization in the middle third of the stomach (p = 0.001), well differentiated tumors (p = 0.001) and intestinal tumor type according to Laurén’s classification (p = 0.03). From the obtained data a prognostic index was constructed, dividing the patients into three risk groups: low (n = 73), intermediate (n = 274), and poor (n = 63). The three groups had significantly different clinical (p = 0.007) and histopathological response rates (p = 0.001) and survival times, with a median survival time that was not reached in the low-risk group, 39.2 months in the intermediate-risk group and 20.5 months in the poor-risk group. The corresponding 5-year survival rates were 65.3, 41.2, and 21.2 % (p < 0.001), respectively. Conclusion: A simple scoring system based on three clinicopathologic parameters, accurately predicts response and prognosis in neoadjuvant treated gastric cancer. This system provides additional useful information that could be applied to select gastric cancer patients pretherapeutically for different treatment approaches. Prospective testing of the score in an independent patient cohort is warranted.


Gastric Cancer Gastric Cancer Patient Advanced Gastric Cancer Prognostic Index Histopathological Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ajani JA, Roth JA, Ryan B, McMurtrey M, Rich TA, Jackson DE, Abbruzzese JL, Levin B, DeCaro L, Mountain C (1990) Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 8(7):1231–1238PubMedGoogle Scholar
  2. Alakus H, Holscher AH, Grass G, Hartmann E, Schulte C, Drebber U, Baldus SE, Bollschweiler E, Metzger R, Monig SP (2010) Extracapsular lymph node spread: a new prognostic factor in gastric cancer. Cancer 116(2):309–315. doi: 10.1002/cncr.24764 PubMedCrossRefGoogle Scholar
  3. Bader FG, Lordick F, Fink U, Becker K, Hofler H, Busch R, Siewert JR, Ott K (2008) Paclitaxel in the neoadjuvant treatment for adeno carcinoma of the distal esophagus (AEG I). A comparison of two phase II trials with long-term follow-up. Onkologie 31 (7):366–372. doi:000135515[pii] 10.1159/000135515 Google Scholar
  4. Baiocchi GL, Tiberio GA, Minicozzi AM, Morgagni P, Marrelli D, Bruno L, Rosa F, Marchet A, Coniglio A, Saragoni L, Veltri M, Pacelli F, Roviello F, Nitti D, Giulini SM, De Manzoni G (2010) A multicentric Western analysis of prognostic factors in advanced, node-negative gastric cancer patients. Ann Surg 252(1):70–73. doi: 10.1097/SLA.0b013e3181e4585e PubMedCrossRefGoogle Scholar
  5. Becker KF, Atkinson MJ, Reich U, Becker I, Nekarda H, Siewert JR, Hofler H (1994) E-cadherin gene mutations provide clues to diffuse type gastric carcinomas. Cancer Res 54(14):3845–3852PubMedGoogle Scholar
  6. Becker K, Mueller JD, Schulmacher C, Ott K, Fink U, Busch R, Bottcher K, Siewert JR, Hofler H (2003) Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 98(7):1521–1530. doi: 10.1002/cncr.11660 PubMedCrossRefGoogle Scholar
  7. Bilici A, Seker M, Ustaalioglu BB, Kefeli U, Yildirim E, Yavuzer D, Aydin FM, Salepci T, Oncel M, Gumus M (2010) Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection. Ann Surg Oncol 17(8):2037–2044. doi: 10.1245/s10434-010-1027-y PubMedCrossRefGoogle Scholar
  8. Boige V, Pignon J, Saint-Aubert B, Lasser P, Conroy T, Bouché O, Segol P, Bedenne L, Rougier P, Ychou M (2007) Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol ASCO Annu Meet Proc [I] 25(18S):4510 (June 20 Supplement)Google Scholar
  9. Boku N, Ohtsu A, Nagashima F, Shirao K, Koizumi W (2007) Relationship between expression of vascular endothelial growth factor in tumor tissue from gastric cancers and chemotherapy effects: comparison between S-1 alone and the combination of S-1 plus CDDP. Jpn J Clin Oncol 37(7):509–514. doi: hym05710.1093/jjco/hym057 [pii]PubMedCrossRefGoogle Scholar
  10. Chiaravalli AM, Cornaggia M, Furlan D, Capella C, Fiocca R, Tagliabue G, Klersy C, Solcia E (2001) The role of histological investigation in prognostic evaluation of advanced gastric cancer. Analysis of histological structure and molecular changes compared with invasive pattern and stage. Virchows Arch 439(2):158–169PubMedCrossRefGoogle Scholar
  11. Choi MG, Sung CO, Noh JH, Kim KM, Sohn TS, Kim S, Bae JM (2010) Mucinous gastric cancer presents with more advanced tumor stage and weaker beta-catenin expression than nonmucinous cancer. Ann Surg Oncol 17(11):3053–3058. doi: 10.1245/s10434-010-1184-z PubMedCrossRefGoogle Scholar
  12. Costa ML, de Cassia Braga Ribeiro K, Machado MA, Costa AC, Montagnini AL (2006) Prognostic score in gastric cancer: the importance of a conjoint analysis of clinical, pathologic, and therapeutic factors. Ann Surg Oncol 13 (6):843–850. doi: 10.1245/ASO.2006.05.040
  13. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, Participants MT (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355(1):11–20. doi: 355/1/1110.1056/NEJMoa055531 [pii]PubMedCrossRefGoogle Scholar
  14. De Vita F, Giuliani F, Galizia G, Belli C, Aurilio G, Santabarbara G, Ciardiello F, Catalano G, Orditura M (2007) Neo-adjuvant and adjuvant chemotherapy of gastric cancer. Ann Oncol 18 (Suppl 6):vi120–123. doi:18/suppl_6/vi120[pii] 10.1093/annonc/mdm239
  15. Fareed KR, Kaye P, Soomro IN, Ilyas M, Martin S, Parsons SL, Madhusudan S (2009) Biomarkers of response to therapy in oesophago-gastric cancer. Gut 58(1):127–143. doi: 58/1/12710.1136/gut.2008.155861 [pii]PubMedCrossRefGoogle Scholar
  16. Fareed KR, Al-Attar A, Soomro IN, Kaye PV, Patel J, Lobo DN, Parsons SL, Madhusudan S (2010) Tumour regression and ERCC1 nuclear protein expression predict clinical outcome in patients with gastro-oesophageal cancer treated with neoadjuvant chemotherapy. Br J Cancer 102(11):1600–1607. doi: 66056810.1038/sj.bjc.6605686 [pii]PubMedCrossRefGoogle Scholar
  17. Fink U, Schuhmacher C, Stein HJ, Busch R, Feussner H, Dittler HJ, Helmberger A, Bottcher K, Siewert JR (1995) Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg 82(9):1248–1252PubMedCrossRefGoogle Scholar
  18. Gibson MK, Abraham SC, Wu TT, Burtness B, Heitmiller RF, Heath E, Forastiere A (2003) Epidermal growth factor receptor, p53 mutation, and pathological response predict survival in patients with locally advanced esophageal cancer treated with preoperative chemoradiotherapy. Clin Cancer Res 9(17):6461–6468PubMedGoogle Scholar
  19. Green D, Ponce de Leon S, Leon-Rodriguez E, Sosa-Sanchez R (2002) Adenocarcinoma of the stomach: univariate and multivariate analysis of factors associated with survival. Am J Clin Oncol 25(1):84–89PubMedCrossRefGoogle Scholar
  20. Greene FL, Fleming ID, Fritz A, Balch CM (2002) AJCC cancer staging manual, 6th edn. Springer, New YorkGoogle Scholar
  21. Harrison JD, Fielding JW (1995) Prognostic factors for gastric cancer influencing clinical practice. World J Surg 19(4):496–500PubMedCrossRefGoogle Scholar
  22. Hohenberger P, Gretschel S (2003) Gastric cancer. Lancet 362(9380):305–315. doi: S014067360313975X [pii]PubMedCrossRefGoogle Scholar
  23. Inoue K, Nakane Y, Iiyama H, Sato M, Kanbara T, Nakai K, Okumura S, Yamamichi K, Hioki K (2002a) The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 9(1):27–34PubMedCrossRefGoogle Scholar
  24. Inoue H, Matsuyama A, Mimori K, Ueo H, Mori M (2002b) Prognostic score of gastric cancer determined by cDNA microarray. Clin Cancer Res 8(11):3475–3479PubMedGoogle Scholar
  25. Jhawer M, Coit D, Brennan M, Qin LX, Gonen M, Klimstra D, Tang L, Kelsen DP, Shah MA (2009) Perineural invasion after preoperative chemotherapy predicts poor survival in patients with locally advanced gastric cancer: gene expression analysis with pathologic validation. Am J Clin Oncol 32(4):356–362. doi: 10.1097/COC.0b013e31818c08e8 PubMedCrossRefGoogle Scholar
  26. Johnson H, Belluco C, Masood S, Azama A, Kahn L, Wise L (1995) Preoperative factors of prognostic significance in gastric cancer. J Natl Med Assoc 87(6):423–426PubMedGoogle Scholar
  27. Kattan MW, Karpeh MS, Mazumdar M, Brennan MF (2003) Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol 21(19):3647–3650. doi: 10.1200/JCO.2003.01.240-JCO.2003.01.240 [pii]PubMedCrossRefGoogle Scholar
  28. Kelsen D, Karpeh M, Schwartz G, Gerdes H, Lightdale C, Botet J, Lauers G, Klimstra D, Huang Y, Saltz L, Quan V, Brennan M (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 14(6):1818–1828PubMedGoogle Scholar
  29. Kim YH, Lee HS, Lee HJ, Hur K, Kim WH, Bang YJ, Kim SJ, Lee KU, Choe KJ, Yang HK (2004) Prognostic significance of the expression of Smad4 and Smad7 in human gastric carcinomas. Ann Oncol 15(4):574–580PubMedCrossRefGoogle Scholar
  30. Kologlu M, Kama NA, Reis E, Doganay M, Atli M, Dolapci M (2000) A prognostic score for gastric cancer. Am J Surg 179(6):521–526. doi: S0002961000003858 [pii]PubMedCrossRefGoogle Scholar
  31. Lauren P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microb Scand 64:31–49Google Scholar
  32. Lenz HJ, Leichman CG, Danenberg KD, Danenberg PV, Groshen S, Cohen H, Laine L, Crookes P, Silberman H, Baranda J, Garcia Y, Li J, Leichman L (1996) Thymidylate synthase mRNA level in adenocarcinoma of the stomach: a predictor for primary tumor response and overall survival. J Clin Oncol 14(1):176–182PubMedGoogle Scholar
  33. Letai AG (2008) Diagnosing and exploiting cancer’s addiction to blocks in apoptosis. Nat Rev Cancer 8(2):121–132. doi: nrc229710.1038/nrc2297 [pii]PubMedCrossRefGoogle Scholar
  34. Lordick F, Stein HJ, Peschel C, Siewert JR (2004) Neoadjuvant therapy for oesophagogastric cancer. Br J Surg 91(5):540–551. doi: 10.1002/bjs.4575 PubMedCrossRefGoogle Scholar
  35. Lowy AM, Mansfield PF, Leach SD, Pazdur R, Dumas P, Ajani JA (1999) Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg 229(3):303–308PubMedCrossRefGoogle Scholar
  36. Luthra R, Wu TT, Luthra MG, Izzo J, Lopez-Alvarez E, Zhang L, Bailey J, Lee JH, Bresalier R, Rashid A, Swisher SG, Ajani JA (2006) Gene expression profiling of localized esophageal carcinomas: association with pathologic response to preoperative chemoradiation. J Clin Oncol 24(2):259–267. doi: JCO.2005.03.368810.1200/JCO.2005.03.3688 [pii]PubMedCrossRefGoogle Scholar
  37. Luthra MG, Ajani JA, Izzo J, Ensor J, Wu TT, Rashid A, Zhang L, Phan A, Fukami N, Luthra R (2007) Decreased expression of gene cluster at chromosome 1q21 defines molecular subgroups of chemoradiotherapy response in esophageal cancers. Clin Cancer Res 13(3):912–919. doi: 13/3/91210.1158/1078-0432.CCR-06-1577 [pii]PubMedCrossRefGoogle Scholar
  38. Mansour JC, Tang L, Shah M, Bentrem D, Klimstra DS, Gonen M, Kelsen DP, Brennan MF, Coit DG (2007) Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer? Ann Surg Oncol 14(12):3412–3418. doi: 10.1245/s10434-007-9574-6 PubMedCrossRefGoogle Scholar
  39. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, Roviello F, de Manzoni G, Minicozzi A, Natalini G, De Santis F, Baiocchi L, Coniglio A, Nitti D (2007) The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg 245(4):543–552. doi: 10.1097/01.sla.0000250423.43436.e100000658-200704000-00009 [pii]PubMedCrossRefGoogle Scholar
  40. Marchet A, Mocellin S, Ambrosi A, de Manzoni G, Di Leo A, Marrelli D, Roviello F, Morgagni P, Saragoni L, Natalini G, De Santis F, Baiocchi L, Coniglio A, Nitti D (2008) The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol 34(2):159–165. doi: S0748-7983(07)00207-710.1016/j.ejso.2007.04.018 [pii]PubMedCrossRefGoogle Scholar
  41. Marubini E, Bonfanti G, Bozzetti F, Boracchi P, Amadori D, Folli S, Nanni O, Gennari L (1993) A prognostic score for patients resected for gastric cancer. Eur J Cancer 29A(6):845–850PubMedCrossRefGoogle Scholar
  42. Mikami K, Maekawa T, Shinohara T, Hoshino S, Yamauchi Y, Noritomi T, Yamashita Y (2009) Predictive factors of early recurrent death after a curative resection of gastric cancer. Int Surg 94(2):144–148PubMedGoogle Scholar
  43. Miyazono F, Metzger R, Warnecke-Eberz U, Baldus SE, Brabender J, Bollschweiler E, Doerfler W, Mueller RP, Dienes HP, Aikou T, Hoelscher AH, Schneider PM (2004) Quantitative c-erbB-2 but not c-erbB-1 mRNA expression is a promising marker to predict minor histopathologic response to neoadjuvant radiochemotherapy in oesophageal cancer. Br J Cancer 91(4):666–672. doi: 10.1038/sj.bjc.66019766601976 [pii]PubMedGoogle Scholar
  44. Msika S, Benhamiche AM, Jouve JL, Rat P, Faivre J (2000) Prognostic factors after curative resection for gastric cancer. A population-based study. Eur J Cancer 36(3):390–396. doi: S0959-8049(99)00308-1 [pii]PubMedCrossRefGoogle Scholar
  45. Nagashima F, Boku N, Ohtsu A, Yoshida S, Hasebe T, Ochiai A, Sakata Y, Saito H, Miyata Y, Hyodo I, Ando M (2005) Biological markers as a predictor for response and prognosis of unresectable gastric cancer patients treated with irinotecan and cisplatin. Jpn J Clin Oncol 35(12):714–719. doi: hyi19410.1093/jjco/hyi194 [pii]PubMedCrossRefGoogle Scholar
  46. Ninomiya Y, Yanagisawa A, Kato Y, Kitagawa T, Ishihara S, Nakajima T (1999) Histological indications of a favorable prognosis with far-advanced gastric carcinomas after preoperative chemotherapy. J Cancer Res Clin Oncol 125(12):699–706. doi: 91250699.432 [pii]PubMedCrossRefGoogle Scholar
  47. Ott K, Sendler A, Becker K, Dittler HJ, Helmberger H, Busch R, Kollmannsberger C, Siewert JR, Fink U (2003a) Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study. Gastric Cancer 6(3):159–167. doi: 10.1007/s10120-003-0245-4 Google Scholar
  48. Ott K, Fink U, Becker K, Stahl A, Dittler HJ, Busch R, Stein H, Lordick F, Link T, Schwaiger M, Siewert JR, Weber WA (2003b) Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial. J Clin Oncol 21(24):4604–4610. doi: 10.1200/JCO.2003.06.574 JCO.2003.06.574 [pii]Google Scholar
  49. Ott K, Lordick F, Herrmann K, Krause BJ, Schuhmacher C, Siewert JR (2008a) The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies. Gastric Cancer 11(1):1–9. doi: 10.1007/s10120-007-0448-1 Google Scholar
  50. Ott K, Lordick F, Becker K, Ulm K, Siewert J, Hofler H, Keller G (2008b) Glutathione-S-transferase P1, T1 and M1 genetic polymorphisms in neoadjuvant-treated locally advanced gastric cancer: GSTM1-present genotype is associated with better prognosis in completely resected patients. Int J Colorectal Dis 23(8):773–782. doi: 10.1007/s00384-008-0490-4 Google Scholar
  51. Ott K, Herrmann K, Lordick F, Wieder H, Weber WA, Becker K, Buck AK, Dobritz M, Fink U, Ulm K, Schuster T, Schwaiger M, Siewert JR, Krause BJ (2008c) Early metabolic response evaluation by fluorine-18 fluorodeoxyglucose positron emission tomography allows in vivo testing of chemosensitivity in gastric cancer: long-term results of a prospective study. Clin Cancer Res 14(7):2012–2018. doi:14/7/2012[pii] 10.1158/1078-0432.CCR-07-0934 Google Scholar
  52. Ott K, Bader FG, Lordick F, Feith M, Bartels H, Siewert JR (2009) Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patients at an experienced center. Ann Surg Oncol 16(4):1017–1025. doi: 10.1245/s10434-009-0336-5 PubMedCrossRefGoogle Scholar
  53. Park SR, Kim MJ, Ryu KW, Lee JH, Lee JS, Nam BH, Choi IJ, Kim YW (2010) Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatment. Ann Surg 251(3):428–435. doi: 10.1097/SLA.0b013e3181ca69a700000658-201003000-00008 [pii]PubMedCrossRefGoogle Scholar
  54. Persiani R, D’Ugo D, Rausei S, Sermoneta D, Barone C, Pozzo C, Ricci R, La Torre G, Picciocchi A (2005) Prognostic indicators in locally advanced gastric cancer (LAGC) treated with preoperative chemotherapy and D2-gastrectomy. J Surg Oncol 89 (4):227–236 discussion 237–228. doi: 10.1002/jso.20207 Google Scholar
  55. Rohatgi PR, Mansfield PF, Crane CH, Wu TT, Sunder PK, Ross WA, Morris JS, Pisters PW, Feig BW, Gunderson LL, Ajani JA (2006) Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma. Cancer 107(7):1475–1482. doi: 10.1002/cncr.22180 PubMedCrossRefGoogle Scholar
  56. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18):1810–1820. doi: 357/18/181010.1056/NEJMoa072252 [pii]PubMedCrossRefGoogle Scholar
  57. Schuhmacher CP, Fink U, Becker K, Busch R, Dittler HJ, Mueller J, Siewert JR (2001) Neoadjuvant therapy for patients with locally advanced gastric carcinoma with etoposide, doxorubicin, and cisplatinum. Closing results after 5 years of follow-up. Cancer 91(5):918–927. doi: 10.1002/1097-0142(20010301)91:5<918::AID-CNCR1081>3.0.CO;2-W[pii]Google Scholar
  58. Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, Haag C, Mauer ME, Hasan B, Welch J, Ott K, Hoelscher A, Schneider PM, Bechstein W, Wilke H, Lutz MP, Nordlinger B, Cutsem EV, Siewert JR, Schlag PM (2010a) Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European organisation for research and treatment of cancer randomized trial 40954. J Clin Oncol 28(35):5210–5218. doi: JCO.2009.26.611410.1200/JCO.2009.26.6114 [pii]PubMedCrossRefGoogle Scholar
  59. Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, Haag C, Mauer ME, Hasan B, Welch J, Ott K, Hoelscher A, Schneider PM, Bechstein W, Wilke H, Lutz MP, Nordlinger B, Van Cutsem E, Siewert JR, Schlag PM (2010b) Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European organisation for research and treatment of cancer randomized trial 40954. J Clin Oncol. doi: JCO.2009.26.611410.1200/JCO.2009.26.6114 [pii]PubMedGoogle Scholar
  60. Shiao YH, Palli D, Caporaso NE, Alvord WG, Amorosi A, Nesi G, Saieva C, Masala G, Fraumeni JF Jr, Rice JM (2000) Genetic and immunohistochemical analyses of p53 independently predict regional metastasis of gastric cancers. Cancer Epidemiol Biomark Prev 9(6):631–633Google Scholar
  61. Shin SH, Bae JM, Jung H, Choi MG, Lee JH, Noh JH, Sohn TS, Kim S (2010) Clinical significance of the discrepancy between preoperative and postoperative diagnoses in gastric cancer patients. J Surg Oncol 101(5):384–388. doi: 10.1002/jso.21500 PubMedGoogle Scholar
  62. Siewert JR, Bottcher K, Stein HJ, Roder JD (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German gastric cancer study. Ann Surg 228(4):449–461PubMedCrossRefGoogle Scholar
  63. Solcia E, Klersy C, Mastracci L, Alberizzi P, Candusso ME, Diegoli M, Tava F, Riboni R, Manca R, Luinetti O (2009) A combined histologic and molecular approach identifies three groups of gastric cancer with different prognosis. Virchows Arch 455(3):197–211. doi: 10.1007/s00428-009-0813-z PubMedCrossRefGoogle Scholar
  64. Stemmermann GN, Brown C (1974) A survival study of intestinal and diffuse types of gastric carcinoma. Cancer 33(4):1190–1195PubMedCrossRefGoogle Scholar
  65. Vallbohmer D, Drebber U, Schneider PM, Baldus S, Bollschweiler E, Brabender J, Warnecke-Eberz U, Monig S, Holscher AH, Metzger R (2009) Survivin expression in gastric cancer: Association with histomorphological response to neoadjuvant therapy and prognosis. J Surg Oncol 99(7):409–413. doi: 10.1002/jso.21271 PubMedCrossRefGoogle Scholar
  66. Weiss MM, Kuipers EJ, Postma C, Snijders AM, Pinkel D, Meuwissen SG, Albertson D, Meijer GA (2004) Genomic alterations in primary gastric adenocarcinomas correlate with clinicopathological characteristics and survival. Cell Oncol 26(5–6):307–317PubMedGoogle Scholar
  67. Yamamoto H, Perez-Piteira J, Yoshida T, Terada M, Itoh F, Imai K, Perucho M (1999) Gastric cancers of the microsatellite mutator phenotype display characteristic genetic and clinical features. Gastroenterology 116(6):1348–1357. doi: S0016508599005491 [pii]PubMedCrossRefGoogle Scholar
  68. Yonemura Y, Ninomiya I, Ohoyama S, Kimura H, Yamaguchi A, Fushida S, Kosaka T, Miwa K, Miyazaki I, Endou Y (1991) Expression of c-erbB-2 oncoprotein in gastric carcinoma. Immunoreactivity for c-erbB-2 protein is an independent indicator of poor short-term prognosis in patients with gastric carcinoma. Cancer 67(11):2914–2918PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.National Center of Tumor Diseases, University of HeidelbergHeidelbergGermany
  2. 2.Department of SurgeryUniversity Hospital of HeidelbergHeidelbergGermany

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