Abstract
Gastric cancer remains a leading cause of cancer-related mortality worldwide. While survival has improved over recent decades, prognosis remains poor. The Laurén classification divides gastric cancer into two histological subtypes—intestinal and diffuse—which differ in epidemiology, clinical outcomes, and response to treatment. These subtypes show distinct pathological features: diffuse gastric cancer (DGC) exhibits a poorly cohesive growth pattern, with tumour cells appearing singly or in small clusters/cords, whereas intestinal gastric cancer (IGC) displays more well differentiated tubular, glandular, or papillary architecture. Desmoplasia, the fibrotic stromal response observed in and around tumours, has been associated with prognosis in several malignancies, but its role in gastric cancer has not been well characterized. This study aims to evaluate whether the presence of desmoplasia is associated with survival in patients with gastric cancer.
A retrospective analysis was performed on a multicentre cohort of patients undergoing curative resection for oesophagogastric cancer in Victoria, Australia, between 1999 and 2009. Desmoplasia was recorded on a scale of zero to three. Participants scored zero when no desmoplasia was present, while those that scored three had florid desmoplasia seen on histology. This was subsequently categorised as either present or absent. The primary endpoint investigated was cancer specific survival.
An improvement in gastric cancer specific survival was seen for patients without desmoplasia compared to those with any degree of desmoplasia present. When stratified by GC subtype, the same effect of desmoplasia on survival was observed. Associations were seen between other clinicopathological variables and desmoplasia including Laurén classification, AJCC stage (severity of the cancer) and participant age.
This analysis demonstrates that desmoplasia is associated with a shorter median survival in GC and this difference is not driven by GC subtype in this cohort. It also identified associations between desmoplasia and the histological subtype, stage of the cancer and participant age.