Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer

Abstract

BACKGROUND Borrmann classification (types I-IV) for the detection of advanced gastric cancer has been accepted worldwide, and lymphatic and/or blood vessel invasion (LBVI) status is related to the poor prognosis after gastric cancer. AIM To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer. METHODS We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013. Categorical variables were evaluated by the Pearson’s χ 2 test, the Kaplan-Meier method was used to identify differences in cumulative survival rates, and the Cox proportional hazards model was used for multivariate prognostic analysis. RESULTS A total of 2604 patients were included in this study. The presence of LVBI [LBVI (+)] and Borrmann type ( P = 0.001), tumor location ( P < 0.001), tumor size ( P < 0.001), histological type ( P < 0.001), tumor invasion depth ( P < 0.001), number of metastatic lymph nodes ( P < 0.001), and surgical method ( P < 0.001) were significantly correlated with survival. When analyzing the combination of the Borrmann classification and LBVI status, we found that patients with Borrmann type III disease and LBVI (+) had a similar 5-year survival rate to those with Borrmann IV + LBVI (-) (16.4% vs 13.1%, P = 0.065) and those with Borrmann IV + LBVI (+) (16.4% vs 11.2%, P = 0.112). Subgroup analysis showed that the above results were true for any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann classification ( P = 0.023), vascular infiltration ( P < 0.001), tumor size ( P = 0.012), pT stage ( P < 0.001), pN stage ( P < 0.001), and extent of radical surgery ( P < 0.001) were independent prognostic factors for survival. CONCLUSION Since patients with Borrmann III disease and LBVI (+) have the same poor prognosis as those with Borrmann IV disease, more attention should be paid to patients with Borrmann III disease and LBVI (+) during diagnosis and treatment, regardless of the pT stage and tumor location, to obtain better survival results.

Are Borrmann’s Types of Advanced Gastric Cancer Distinct Clinicopathological and Molecular Entities? A Western Study

“…Regarding GC prognosis, previous investigations have variably related Borrmann classification to patient outcomes, mainly comparing type IV with type I–III GC. Thus, type IV GC has been identified as an independent prognostic factor in several studies [ 28 , 29 ]. Almost all of these studies have been conducted in Asian countries.…”

A Web-Based Prediction Model for Cancer-Specific Survival of Elderly Patients With Hypopharyngeal Squamous Cell Carcinomas: A Population-Based Study

“…TNM staging is the primary tumor staging system, which is an essential factor in evaluating cancer prognosis ( 28 ). However, precise evaluation of TNM staging can only be obtained after surgery ( 29 ), and prognostic heterogeneity generally exists among patients with the same TNM stage ( 30 ). Hypopharynx is rich in lymphoid tissue and prone to mucosal infiltrative metastases ( 31 ).…”

From Helicobacter pylori infection to gastric cancer: Current evidence on the immune response

“…The early type, limited to the mucosa and submucosa, has a lower degree of development and injury and has a 5-year survival rate of 85% to 90%, while patients with the advanced type have a 5% to 20% survival rate. Furthermore, the advanced type can be evaluated by the Borrmann classification: polypoid (type 1), ulcerated with defined edges (type 2), ulcerated with ill-defined edges (type 3) and plastic linitis, characterized by diffuse infiltrate without evidence of ulceration (type 4)[ 69 ].…”