Cancer Research and Treatment

Special Article

Utilization, Reimbursement, and Barriers to Accessing Sequencing Tests for Cancer Care in the Asia-Pacific Region: KSMO Initiatives to Address Cancer Care Inequity: Omali Pitiyarachchi, Aaron C. Tan, Tawasapon Thambamroong, Rogelio Velasco Jr, Yuji Uehara, Daphne Lee, Hsiang-Fong Kao, Vivek Agarwala, Yueh Ni Lim, Dimas Priantono, Ardhi Rahman Ahani, Kyaw Zin Win, Young Saing Kim, Changhoon Yoo; Cancer Res Treat. 2026;58(4):1025-1036. Published online December 19, 2025; DOI: https://doi.org/10.4143/crt.2025.896

Purpose
The Asia-Pacific region is marked by healthcare diversity and economic disparity.
Materials and Methods
To understand the utilization and reimbursement practices of next-generation sequencing (NGS) and other sequencing methods relevant to oncology clinical practice in the region, a semi-structured survey was undertaken of respondents from 11 countries represented by the Korean Society of Medical Oncology (KSMO) 2024 Young Oncologist Forum alumni.
Results
While 79% of respondents reported access to NGS at their institution, full government reimbursement was uncommon and varied by test type and clinical setting. Japan and South Korea offered the most comprehensive public coverage, including for circulating tumor DNA–based liquid biopsy. Lower- and upper-middle–income countries, such as the Philippines, Indonesia, and India, reported no government reimbursement, thus relying on user-pay methods or private insurance payments. One marked barrier to NGS reimbursement was the prohibitive cost of tests (100%), followed by a limited budget to fund testing (78.6%), and then by policy or regulatory restrictions (50.0%). On a similar note, insurance coverage (92.9%) and patient income (85.7%) were key concerns regarding access and equity to tests. Test reimbursement (or lack thereof) and cost were cited almost universally as the most elevated concerns by the respondents.
Conclusion
The findings demonstrated a wide disparity in access, funding and reimbursement of sequencing tests across the region. Addressing cost, improving reimbursement mechanisms, and building infrastructure capacity will be critical for the equitable integration of NGS into routine cancer care in the Asia-Pacific.

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Accelerating equitable cancer genomics and precision oncology in health care and research: a Lancet Oncology Commission
Raffaella Casolino, Joaquin Mateo, Elisabeth G E de Vries, Amber Johns, Melanie Courtot, Rita T Lawlor, Sandra Perdomo, Stacy W Gray, Raquel Perez-Lopez, Clare Turnbull, David Torrents, Kerstin Noelle Vokinger, Dilara Akhoundova, Jean-Marc Bourque, Andrés
The Lancet Oncology.2026; 27(10): e454. CrossRef

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Original Articles

Head and Neck cancer

Differential Efficacy of Alpelisib by PIK3CA Mutation Site in Head and Neck Squamous Cell Carcinoma: An Analysis from the KCSG HN 15-16 TRIUMPH Trial: Kyoo Hyun Kim, Shinwon Hwang, Min Kyoung Kim, Keon-Uk Park, Tak Yun, Keun-Wook Lee, Joo Hang Kim, Bhumsuk Keam, Byoung Chul Cho, So Yeon Oh, Sang Hee Cho, Sangwoo Kim, Sung-Bae Kim, Min Hee Hong, Hye Ryun Kim; Cancer Res Treat. 2025;57(4):968-980. Published online January 31, 2025; DOI: https://doi.org/10.4143/crt.2024.1195

Abstract PDF Supplementary Material PubReader ePub

Purpose
The TRIUMPH trial was a biomarker-driven umbrella trial for patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). This analysis focuses on the PIK3CAα (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) inhibitor alpelisib (arm 1) in patients with phosphoinositide 3-kinase (PI3K) pathway alterations.
Materials and Methods
Patients with PI3K pathway altered tumors were enrolled in the alpelisib arm of the TRIUMPH study. We conducted a detailed analysis of the correlation between PI3K pathway mutations and treatment outcomes including disease control rate, overall survival (OS), and progression-free survival (PFS).
Results
From October 2017 and August 2020, 203 were enrolled, with 42 treated with alpelisib. Response evaluation was possible for 33 patients. Genomic profiles revealed PIK3CA amplifications in 26.2%, and point mutations in E542K (26.2%), E545K (23.8%), and H1047R (9.5%). Neither PIK3CA amplification nor co-occurring TP53 mutations had a notable influence on alpelisib response or survival outcomes. Although the overall response rates were similar between helical domain mutations (E542, E545) and kinase domain mutation (H1047), patients with H1047 mutation exhibited significantly poorer PFS compared to those with non-H1047 PIK3CA alterations (1.6 vs. 7.3 months, p=0.017). OS in patients with H1047 kinase domain mutation showed a trend toward being shorter compared to others, though this difference did not reach statistical significance.
Conclusion
Alpelisib showed differential efficacy based on PI3K pathway alterations in patients with R/M HNSCC and was well-tolerated. These findings suggest the usefulness of next-generation sequencing testing-based decision-making when using the targeted agents in R/M HNSCC. We need to confirm results in larger cohorts.

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Actualités 2025 par le comité de rédaction du Bulletin du Cancer : congrès ASCO, ESMO et au-delà
Stéphane Vignot, Audrey Bellesoeur, Delphine Borchiellini, Carole Bouleuc, Romain Cohen, Alexandre de Nonneville, Frédéric Delom, Serge Evrard, Nelly Firmin, Virginie Gandemer, Mohamed Khettab, Daniel Orbach, Manuel Rodrigues, Sébastien Thureau, Marie Wis
Bulletin du Cancer.2026; 113(1): 8. CrossRef
Beyond EGFR inhibition in head and neck squamous cell carcinoma: Overcoming resistance mechanisms and novel therapeutic frontiers
Francesca Carosi, Daria Maria Filippini, Laura Fabbri, Andrea Carlini, Andrea Monte, Michela Sgarzi, Matteo Fermi, Giulia Querzoli, Donatella Romaniello, Giuseppe Mercante, Achille Tarsitano, Christophe Le Tourneau, Mattia Lauriola
Critical Reviews in Oncology/Hematology.2026; 221: 105207. CrossRef
Prognostic Biomarkers and Immunotherapeutic Insights of Circulating Tumor DNA Analysis in Advanced Esophageal Squamous Cell Carcinoma From SCRUM-MONSTAR GOZILA Substudy
Yuqing Duan, Tadayoshi Hashimoto, Taro Shibuki, Hiroya Taniguchi, Yu Sunakawa, Yoshito Komatsu, Naoki Takahashi, Yuta Sato, Kensei Yamaguchi, Tomohiro Nishina, Tomonori Nakanoko, Shogen Boku, Taroh Satoh, Hisateru Yasui, Taito Esaki, Mitsuho Imai, Takao F
JCO Precision Oncology.2026;[Epub] CrossRef
Driving progress in recurrent and metastatic head and neck cancer: the NRG Oncology perspective
Mercedes Herrera, Matthew Ward, Glenn J Hanna, Sue S Yom, Dwight Heron, Anna Spreafico
JNCI: Journal of the National Cancer Institute.2026; 118(7): 1158. CrossRef
Functional characterization of PIK3CA E545A mutation in MCF-7 breast cancer cells reveals enhanced proliferation and resistance to Alpelisib
Hoai Thu Le, Nguyen Bao Nghi, Vu Diem My, Hoang Anh Vu, Ma Chi Thanh, Bui Minh Tri, Vo Van Thanh Niem, Huynh Anh Phuong
Biochemical and Biophysical Research Communications.2026; 829: 154189. CrossRef
Recurrent PIK3CA-E545K mutation promotes cervical cancer growth and invasion via AKT/mTOR signaling
Congxiu Huang, Wei Zhang, Xiaoyu Ma, Xuefeng Li, Xiaoge Sun
Molecular Genetics and Genomics.2026;[Epub] CrossRef
PIK3CA Mutations: Are They a Relevant Target in Adult Diffuse Gliomas?
Ana Tomás, Marta Pojo
International Journal of Molecular Sciences.2025; 26(11): 5276. CrossRef

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A Phase II Trial of Nintedanib in Patients with Metastatic or Recurrent Head and Neck Squamous Cell Carcinoma: In-Depth Analysis of Nintedanib Arm from the KCSG HN 15-16 TRIUMPH Trial: Kyoo Hyun Kim, Sun Min Lim, Hee Kyung Ahn, Yun-Gyoo Lee, Keun-Wook Lee, Myung-Ju Ahn, Bhumsuk Keam, Hye Ryun Kim, Hyun Woo Lee, Ho Jung An, Jin-Soo Kim; Cancer Res Treat. 2024;56(1):37-47. Published online July 20, 2023; DOI: https://doi.org/10.4143/crt.2023.433

Abstract PDF PubReader ePub

Purpose
Precision oncology approach for recurrent and metastatic head and neck squamous cell carcinoma (HNSCC) is necessary due to its dismal prognosis. We performed a genomic profile-based umbrella trial of patients with platinum-refractory HNSCC (KCSG-TRIUMPH). Here, we present an in-depth report of the the nintedanib arm (arm 3) of the current trial.
Materials and Methods
The TRIUMPH study was a multicenter, open-label, single-arm phase 2 trial, in which patients were assigned to treatment arms based on next-generation sequencing (NGS)–based, matching genomic profiles. Patients whose tumors harbor fibroblast growth factor receptor (FGFR) alteration were enrolled in the nintedanib arm (arm 3) as part of the TRIUMPH study. The primary endpoint was the overall response rate (ORR), and secondary endpoints included overall survival (OS), progression-free survival (PFS), safety, and biomarker analysis.
Results
Between October 2017 and August 2020, 207 were enrolled in the TRIUMPH study, and eight were enrolled in the nintedanib arm. ORR and disease control rate were 42.9% and 57.1%, respectively. The median PFS was 5.6 months and the median duration of response was 9.1 months. Median OS was 11.1 months. One patient maintained the partial response for 36 months. Overall, the toxicity profiles were manageable.
Conclusion
Single-agent nintedanib has demonstrated significant efficacy in FGFR-mutated, recurrent or metastatic HNSCC patients, with tolerable toxicity profiles. The results from the study have provided the basis for routine NGS screening and FGFR-targeted therapy. Because of the small number of patients due to slow accrual in this study, further studies with a larger cohort are warranted for statistical power.

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Predictive and Prognostic Value of p16 in Head and Neck Squamous Cell Carcinoma Patients Treated with Molecular Targeted Agents or Immune Checkpoint Inhibitors: Subgroup Analysis of the TRIUMPH Study
Hyerim Ha, Sang Hoon Chun, Yun-Gyoo Lee, Hyun Chang, Jang Ho Cho, Der Sheng Sun, Sang Hee Cho, Jung Hye Kwon, Kyoung Eun Lee, In Gyu Hwang, Hyo Jung Kim, Bhumsuk Keam, Seong Hoon Shin, Sung-Bae Kim, Joo Hang Kim, Hwan Jung Yun
Cancer Investigation.2026; 44(5): 479. CrossRef
GARD: Genomic Data-Based Drug Repurposing in Head and Neck Cancer with Large Language Model Validation
Pradham Tanikella, William Nenad, Christophe Courtine, Yifan Dai, Qingying Deng, Baiming Zou, Nosayaba Osazuwa-Peters, Travis P. Schrank, Di Wu
Cancers.2026; 18(5): 757. CrossRef
Expression and prognostic relevance of FGF19-KLB-FGFR4 pathway proteins and tumor microenvironment-related proteins in oral squamous cell carcinoma
Junichi Misumi, Kenichiro Uchida, Ryo Nonaka, Katsuaki Mishima
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology.2026; 38(6): 1256. CrossRef
Fibroblast growth factor receptor signaling in head and neck tumors: molecular pathogenesis and potential therapeutic targets
Luqin Tang, Hanqi Xia, Zhu Zheng, Yuxin Cheng, Zhixuan Huang, Tai Ma
Clinical and Translational Oncology.2026;[Epub] CrossRef
Targeting fibroblast growth factor receptor (FGFR) with inhibitors in head and neck cancers: Their roles, mechanisms and challenges
Daowen Luo, Sirinart Kumfu, Nipon Chattipakorn, Siriporn C. Chattipakorn
Biochemical Pharmacology.2025; 235: 116845. CrossRef
Functional Characterization of Variants of Unknown Significance of Fibroblast Growth Factor Receptors 1-4 and Comparison With AI Model–Based Prediction
Martin Ziegler, Nadira Khoury, Louisa Maxine Hommerich, Heike Adler, Sonja Loges
JCO Precision Oncology.2025;[Epub] CrossRef
Prevalence and biological impact of clinically relevant gene fusions in head and neck cancers
Emily L. Hoskins, Raven Vella, Julie W. Reeser, Michele R. Wing, Eric Samorodnitsky, Altan Turkoglu, Leah Stein, Elizabeth Breuning, Zachary A. Risch, Wilnelly M. Hernandez-Sanchez, Lianbo Yu, Michelle Churchman, Nancy Single, Jad Chahoud, Antonio Jimeno,
npj Precision Oncology.2025;[Epub] CrossRef
Molecular insights into immune evasion in head and neck squamous cell carcinomas: Toward a promising treatment strategy
HYEON JI KIM, BO KYUNG JOO, JIN-SEOK BYUN, DO-YEON KIM
Oncology Research.2025; 33(6): 1271. CrossRef
One-pot synthesis and pharmacological evaluation of new quinoline/pyrimido-diazepines as pulmonary antifibrotic agents
Michael Atef Fawzy, Karim Hagag Ibrahim, Ashraf A Aly, Asmaa H Mohamed, Sara Mohamed Naguib Abdel Hafez, Walaa Yehia Abdelzaher, Eslam B Elkaeed, Aisha A Alsfouk, El-Shimaa MN Abdelhafez
Future Medicinal Chemistry.2024; 16(21): 2211. CrossRef
Critical review of the current and future prospects of VEGF-TKIs in the management of squamous cell carcinoma of head and neck
Prashant Puttagunta, Saagar V. Pamulapati, James E. Bates, Jennifer H. Gross, William A. Stokes, Nicole C. Schmitt, Conor Steuer, Yong Teng, Nabil F. Saba
Frontiers in Oncology.2023;[Epub] CrossRef

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Sarcoma

Comprehensive Molecular Characterization of Soft Tissue Sarcoma for Prediction of Pazopanib-Based Treatment Response: Jung Yong Hong, Hee Jin Cho, Kum-Hee Yun, Young Han Lee, Seung Hyun Kim, Wooyeol Baek, Sang Kyum Kim, Yurimi Lee, Yoon-La Choi, Minsuk Kwon, Hyo Song Kim, Jeeyun Lee; Cancer Res Treat. 2023;55(2):671-683. Published online September 27, 2022; DOI: https://doi.org/10.4143/crt.2022.251

Abstract PDF Supplementary Material PubReader ePub

Purpose
Even though pazopanib, a multitargeted tyrosine kinase inhibitor, has been approved for refractory soft tissue sarcoma (STS), little is known about the molecular determinants of the response to pazopanib. We performed integrative molecular characterization to identify potential predictors of pazopanib efficacy.
Materials and Methods
We obtained fresh pre-treatment tumor tissue from 35 patients with advanced STS receiving pazopanib-based treatment. Among those, 18 (51.4%) received pazopanib monotherapy, and the remaining 17 (48.6%) received pazopanib in combination with durvalumab, programmed death-ligand 1 blockade. Whole-exome and transcriptome sequencing were performed for each tumor and patient germline DNA.
Results
Of the 35 patients receiving pazopanib-based treatment, nine achieved a partial response (PR), resulting in an objective response rate (ORR) of 27.3%, and the median progression-free survival (PFS) was 6.0 months. Patients with CDK4 amplification (copy ratio tumor to normal > 2) exhibited shorter PFS (3.7 vs. 7.9 months, p=2.09×10–4) and a poorer response (ORR; 0% vs. 33.3%) compared to those without a gene amplification (copy ratio ≤ 2). Moreover, non-responders demonstrated transcriptional activation of CDK4 via DNA amplification, resulting in cell cycle activation. In the durvalumab combination cohort, seven of the 17 patients (41.2%) achieved a PR, and gene expression analysis revealed that durvalumab responders exhibited high immune/stromal cell infiltration, mainly comprising natural killer cells, compared to non-responders as well as increased expression of CD19, a B-cell marker.
Conclusion
Despite the limitation of heterogeneity in the study population and treatment, we identified possible molecular predictors of pazopanib efficacy that can be employed in future clinical trials aimed at evaluating therapeutic strategies.

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A systematic review and meta-analysis of pazopanib efficacy and adverse effects in sarcomas
Fernanda Picozzi, Alessandro Ottaiano, Antonella Lucia Marretta, Mariachiara Santorsola, Lucia Cannella, Antonio Pizzolorusso, Francesco Caraglia, Giuseppina Della Vittoria Scarpati, Alessandra Bracigliano, Ottavia Clemente, Ines Simeone, Michele Caraglia
Journal of Translational Medicine.2026;[Epub] CrossRef
Prognostic value of nutritional and inflammation-based scores in advanced soft tissue sarcoma treated with trabectedin: a multicenter study
Seda Jeral Evinç, Çağla Eyüpler Akmercan, Selin Cebeci, Zeliha Birsin, İsmail Nazlı, Ali Kaan Güren, Selver Işık, Bahadır Köylü, İlknur Deliktaş Onur, Tugay Atasever, Tuğba Kaya, Emir Çerme, Murat Günaltılı, Berrin Papila, Nebi Serkan Demirci, Çiğdem Papi
Frontiers in Oncology.2026;[Epub] CrossRef
Role of Genetics in Sarcoma for the Practicing General Surgeon
Matthew Steensma
Surgical Clinics of North America.2026; 106(4): 619. CrossRef
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Xiao Ma, Eloy Yinwang, Xupeng Chai, Fangqian Wang, Zehao Chen, Shengdong Wang, Hao Zhou, Yucheng Xue, Jiangchu Lei, Fanglu Chen, Hengyuan Li, Shixin Chen, Shenzhi Zhao, Kelei Wang, Liang Chen, Junjie Gao, Zhaoming Ye, Nong Lin
MedComm.2025;[Epub] CrossRef
Durvalumab plus pazopanib combination in patients with advanced soft tissue sarcomas: a phase II trial
Hee Jin Cho, Kum-Hee Yun, Su-Jin Shin, Young Han Lee, Seung Hyun Kim, Wooyeol Baek, Yoon Dae Han, Sang Kyum Kim, Hyang Joo Ryu, Joohee Lee, Iksung Cho, Heounjeong Go, Jiwon Ko, Inkyung Jung, Min Kyung Jeon, Sun Young Rha, Hyo Song Kim
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The high-density lipoprotein binding protein HDLBP is an unusual RNA-binding protein with multiple roles in cancer and disease
Jonathan Feicht, Ralf-Peter Jansen
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Intracranial Relapse in Pediatric Sarcoma
Danielle E. Smith, Tyler Hamby, Kenneth Heym, Ashraf Mohamed, Kelly L. Vallance, Anish Ray
Journal of Pediatric Hematology/Oncology.2023; 45(7): e810. CrossRef

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General

Interlaboratory Comparison Study (Ring Test) of Next-Generation Sequencing–Based NTRK Fusion Detection in South Korea: Seung Eun Lee, Mi-Sook Lee, Yoon Kyung Jeon, Hyo Sup Shim, Jun Kang, Jihun Kim, Yoon-La Choi; Cancer Res Treat. 2023;55(1):28-40. Published online February 10, 2022; DOI: https://doi.org/10.4143/crt.2021.1572

Abstract PDF Supplementary Material PubReader ePub

Purpose
Tropomyosin receptor kinase (TRK) inhibitors are approved for the treatment of neurotrophic receptor tyrosine kinase (NTRK) fusion-positive tumors. The detection of NTRK fusion using a validated method is required before therapeutic application. An interlaboratory comparison study of next-generation sequencing (NGS)–based NTRK gene fusion detection with validated clinical samples was conducted at six major hospitals in South Korea.
Materials and Methods
A total of 18 samples, including a positive standard reference and eight positive and nine negative clinical samples, were validated using the VENTANA pan-TRK (EPR17341) and TruSight Oncology 500 assays. These samples were then tested using four different NGS panels currently being used at the six participating institutions.
Results
NTRK fusions were not detected in any of the nine negative clinical samples, demonstrating 100% specificity in all six participating institutions. All assays showed 100% analytical sensitivity to identify the NTRK fusion status in formalin-fixed paraffin-embedded (FFPE) samples, although with variable clinical sensitivity. False-negative results were due to low tumor purity, poor RNA quality, and DNA-based sequencing panel. The RNA-based targeted NGS assay showed an overall high success rate of identifying NTRK fusion status in FFPE samples.
Conclusion
This study is the first to test the proficiency of NGS-based NTRK detection in South Korea with the largest participating institutions. RNA-based NGS assays to detect NTRK fusions can accurately characterize fusion transcripts if sufficient RNA of adequate quality is available. The comparative performance data will support the implementation of targeted NGS-based sequencing assays for NTRK fusion detection in routine diagnostics.

Citations

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Decoding salivary gland tumor complexities through omics integration: A systematic analysis across the 21st century
Gustavo de Souza Vieira, João Figueira Scarini, Nívia Castro Binda, Jaime Rissi Passarini Junior, Albina Altemani, Cristiane Helena Squarize, Rogerio Moraes Castilho, Fernanda Viviane Mariano
Critical Reviews in Oncology/Hematology.2026; 223: 105331. CrossRef
Stepwise identification of an SQSTM1::NTRK3 fusion in papillary thyroid carcinoma: Diagnostic pitfalls and the value of integrative genomic profiling
Yoichiro Okubo, Mei Kadoya, Soji Toda, Ryuji Nasu, Shu Yuguchi, Kota Washimi, Shinya Sato, Yukihiko Hiroshima, Hiroyuki Hayashi, Katsuhiko Masudo, Yohei Miyagi
Pathology - Research and Practice.2025; 272: 156100. CrossRef
Efficient Identification of Patients With NTRK Fusions Using a Supervised Tumor-Agnostic Approach
Susana Hernandez, Esther Conde, Aida Molero, Ana Suarez-Gauthier, Rebeca Martinez, Marta Alonso, Carlos Plaza, Carmen Camacho, Debora Chantada, Laura Juaneda-Magdalena, Enrique Garcia-Toro, Patricia Saiz-Lopez, Federico Rojo, Mar Abad, Valentina Boni, Sof
Archives of Pathology & Laboratory Medicine.2024; 148(3): 318. CrossRef
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part III. Management of Advanced Differentiated Thyroid Cancers - Chapter 4. Systemic Therapy for Progressive Radioiodine-Refractory Differentiated Thyroid Cancer 2
Dong Yeob Shin, Ho-Cheol Kang, Sun Wook Kim, Dong Gyu Na, Young Joo Park, Young Shin Song, Eun Kyung Lee, Dong-Jun Lim, Yun Jae Chung, Won Gu Kim
International Journal of Thyroidology.2024; 17(1): 168. CrossRef
CANTRK
Tracy L. Stockley, Bryan Lo, Adrian Box, Andrea Gomez Corredor, John DeCoteau, Patrice Desmeules, Harriet Feilotter, Daria Grafodatskaya, Wenda Greer, Cynthia Hawkins, Weei Yuarn Huang, Iyare Izevbaye, Guylaine Lépine, Sebastiao N. Martins Filho, Andreas
The Journal of Molecular Diagnostics.2023; 25(3): 168. CrossRef
NTRK Fusion in a Cohort of BRAF p. V600E Wild-Type Papillary Thyroid Carcinomas
Seung Eun Lee, Mi-Sook Lee, Heejin Bang, Mi Young Kim, Yoon-La Choi, Young Lyun Oh
Modern Pathology.2023; 36(8): 100180. CrossRef
Validation and Clinical Application of ONCOaccuPanel for Targeted Next-Generation Sequencing of Solid Tumors
Moonsik Kim, Changseon Lee, Juyeon Hong, Juhee Kim, Ji Yun Jeong, Nora Jee-Young Park, Ji-Eun Kim, Ji Young Park
Cancer Research and Treatment.2023; 55(2): 429. CrossRef

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Clinical Analysis and Prognosis According to the Histopathologic Type of Advanced Gastric Cancer: Sung Ha Moon, Hyun Uk Shin, Jung Weon Shim, Hae Kyung Ahn, Kyung Suk Chung; J Korean Cancer Assoc. 1994;26(5):711-722.

Abstract PDF: The prognostic significance of histologic ciassifications in patients with advanced gastric cancer has been controversiaL The purpose of this study was to clarify clinical characteristics according to the Lauren's and Ming's classifications and to assess the implication of both classifications as a prognostic factor in advanced gastric cancer. The clinical characteristics accordin& to the histologic classifications were evaluated in 238 patients with advanced gastric cancer who underwent gastrectomy between 1984 and 1993. The authors also investigated whether the Lauren's and Ming's classifications represent a prognostic parameter by log-rank test and Cox proportional hazards models. Two hundred thirty eight patients were classified as intestinal (ll4/238, 48%), diffuse (111/ 238, 47%), and mixed(13/238, 5%), according to Lauren; and as expanding(112/238, 47%) and infiltrative (126/238, 53%), according to Ming. Carcinomas of intestinal type (n= 114) were mostly expanding type (n=101), and carcinomas of diffuse type (n= 111) were mostly infiltrative type (n=105). The percentages of diffuse or in- filtrative type with young age, Borrmann type III or IV, poorly differentiation, and T3-T4 inva- sion were significantly greater than those of intestinal or expanding type, respectively, but no significant differences in types of Laurens or Mings classifications were found with regard to the tumor size, regional 1ymph node metastasis and distant metastasis. The 5-year survival rate of patients with intestinal type (51.4%) was higher than those of patients with mixed type (45.8%) or diffuse type (30.5%). The 5-year survival rate of patient with expanding type (53.9%) was higher than that of patients with infiltrative type(29.6%). Multivariate analysis by Cox proportional hazards models revealed that primary tumor(T), Borrmann type, Lauren's classification, and regional lymph node(N) were significant prognostic factors. These results suggest that there are similarities between Lauren's and Ming's classification in regard of age or sex distribution, Borrmann type, tumor invasion, histologic differentiation, and 5-year survival rate. The combination of WHO histologic type with Lauren's and Mings classifications may provide a fairly complete picture of gastric cancer for prognostic purpose.

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Clinicopathologic Findings of Early Gastic Cancer: Young Bae Ko, Won Gon Kim, Joon Mee Kim; J Korean Cancer Assoc. 1999;31(1):62-71.

Abstract PDF: PURPOSE
The prognosis forearly gastric cancer (EGC) is generally excellent after curative gastrectomy alone. However, the EGC of young patients was generally more invasive and metastasizing, and the prognosis of them was poorer than those of the elderly. We performed a retrospective study to evaluate clinica1 and pathological factors influencing the prognosis of EGC.
MATERIALS AND METHODS
The authors investigated 66 cases of EGC resected at Inha Hospital in Song-Nam, from January 1987 to December 1996. We analyzed 9 clinicopathologic factors: age, sex, macroscopic type, tumor size, depth of invasion, location, lymph node metastasis, Williss classification and Laurens classification.
RESULTS
Out of 66 cases (42 males, 24 females) of EGC, the sex ratio (M: F) was 1.75: 1, and the mean age was 55.5 years in male and 54.3 in female. The age incidence revealed a greater prevalence on 6th decade (33.3%). The most common macroscopic type of EGC was IIb and its combined type (43 cases, 65.2%). In tumor size, 16 cases (24.2%) were between 2.0 and 2.9 cm, and 13 cases (19.6%) between 1.0 and 1.9 cm, 10 cases (15%) between 3.0 and 3.9 cm. The tumors smaller than 2.0 cm were 33.2% but greater than 5.0 cm were 18.8%. In male, mucosal lesions were more common (66.6%) than submucosal lesions (33.4%); but in female, the incidence of both types of lesions were the same. The submucosal lesion in female was the most frequent at 4th decade. The major location of EGC was antrum (51.5%). Lymph node metastases were found in 3 females and 1 male. By Williss classification, poorly differentiated adenocarcinoma and signet ring cell carcinoma were more common in female (29.2%, 25%) than in male (11.9%, 14.3%). By Laurens classification, the diffuse type was more common in female (50%) than in male (33.3%). This type was the most frequent in 4th decade female patients. However, none of the above data reached statistical significance.
CONCLUSION
We found the generalized tendency, though not statistically confinned, that the young female patients of EGC frequently had larger and poorly differentiated, diffuse adenocarcinomas with more frequent lymph node metastasis than male. The authors emphasizes that a further study would be needed in young female patients of EGC on hormonal factors influencing its clinicopathologic findings.

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