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World J Gastroenterol. May 21, 2014; 20(19): 5679-5684
Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5679
Pathohistological classification systems in gastric cancer: Diagnostic relevance and prognostic value
Felix Berlth, Elfriede Bollschweiler, Uta Drebber, Arnulf H Hoelscher, Stefan Moenig
Felix Berlth, Elfriede Bollschweiler, Arnulf H Hoelscher, Stefan Moenig, Department of General, Visceral and Cancer Surgery, University of Cologne, 50937 Cologne, Germany
Uta Drebber, Department of Pathology, University of Cologne, 50937 Cologne, Germany
Author contributions: Moenig S, Bollschweiler E and Hoelscher AH contributed ideas from previous publications regarding different classification systems of gastric cancer and also pointed out the position of the German S3 guideline; As an expert pathologist, Drebber U reviewed the manuscript from a pathological point of view and described the clinical routine concerning the diagnosis and classification of gastric cancer; Berlth F generated the topic of the article and wrote the manuscript.
Correspondence to: Stefan Moenig, Professor, Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. stefan.moenig@uk-koeln.de
Telephone: +49-221-4786273 Fax: +49-221-4787440
Received: October 29, 2013
Revised: January 13, 2014
Accepted: February 16, 2014
Published online: May 21, 2014
Abstract

Several pathohistological classification systems exist for the diagnosis of gastric cancer. Many studies have investigated the correlation between the pathohistological characteristics in gastric cancer and patient characteristics, disease specific criteria and overall outcome. It is still controversial as to which classification system imparts the most reliable information, and therefore, the choice of system may vary in clinical routine. In addition to the most common classification systems, such as the Laurén and the World Health Organization (WHO) classifications, other authors have tried to characterize and classify gastric cancer based on the microscopic morphology and in reference to the clinical outcome of the patients. In more than 50 years of systematic classification of the pathohistological characteristics of gastric cancer, there is no sole classification system that is consistently used worldwide in diagnostics and research. However, several national guidelines for the treatment of gastric cancer refer to the Laurén or the WHO classifications regarding therapeutic decision-making, which underlines the importance of a reliable classification system for gastric cancer. The latest results from gastric cancer studies indicate that it might be useful to integrate DNA- and RNA-based features of gastric cancer into the classification systems to establish prognostic relevance. This article reviews the diagnostic relevance and the prognostic value of different pathohistological classification systems in gastric cancer.

Keywords: Gastric cancer, classification, Laurén, World Health Organization classification, Pathohistology

Core tip: The establishment of a pathohistological classification system for gastric cancer with significant prognostic relevance is highly desirable. Numerous classification systems have been introduced by different authors. Although none of them could reach a consensus, the Laurén classification and the World Health Organization classification are widely used. The characteristics of each classification system as well as the prospect for future developments are presented in this article.