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Background. The prognostic significance of the histological
type in gastric cancer is still debated. The correlation
between intestinal-diffuse type and tumor recurrence was
investigated in a prospective multicentric study which col –
lects the cases from three surgical Departments of Italy.
Patients and Metheds. Four-hundred and twelve patients
who underwent a potentially curative resection between
1988 and 1995 were considered; 273 cases were classified
as intestinal type (group A), and 139 cases as diffuse type
(group B). Mixed cases were excluded from the study. All
patients were included in a complete follow-up program for
the early diagnosis of recurrence. Clinical, histopathological
and surgical factors were examined for their influence on
tumor recurrence by univariate and multivariate analysis.
Results. Recurrence rate was 41.4% in intestinal type, and
65.5% in diffuse type cases (p<0.0001). In group A, multivariate analysis identified nodal status (p<0.0001), depth of invasion (p<0.005), lymph node dis - section (D1 vs. D2-D4, p<0.01), advanced age (p<0.01) and male sex (p<0.05) as significant prognostic factors. In group B, depth of invasion (p<0.0005), lymph node dis - section (p<0.005), tumor size (p<0.01) and nodal status (p<0.05) resulted as significant variables; no preventive effect on tumor recurrence was found for D2 vs. D1 lymphadenectomy. Multivariate analysis performed on the totality of the cases demonstrated diffuse type as an inde - pendent predictor of poor prognosis (relative risk: 1.67, p<0.001). Conclusions. Diffuse type of gastric cancer is an indepen - dent risk factor for tumor recurrence as compared with inte - stinal type; clinical and pathological variables play a dif - ferent role as prognostic factors in the two histotypes.