Clinicopathologic Characteristics of Borrmann Type 4 Gastric Cancer

PURPOSE: More than half the Korean gastric cancer patients are diagnosed at a late stage. An understanding of the clinicopathological characteristics of advanced cases is warranted, especially in order to give tailor-made treatments. METHODS: Ninety-five Borrmann type 4 gastric cancer patients, who received surgical treatment at the Department of Surgery, Hanyang University Hospital during the period between June 1992 and December 2001, were enrolled in this study. Several clinicopathological profiles of these Borrmann type 4 gastric cancers were compared to those of Borrmann types 1, 2, and 3. Thereafter, univariate and multivariate survival analyses on the type 4 were performed. RESULTS: Compared to the other macroscopic types, Borrmann type 4 gastric cancer patients showed several significant features: as for clinicopathological factors; there was a prominence of female, young-aged patients, a larger tumor size, higher rates of entire stomach cancer and late stage cases, and as for treatment-related factors; there was a higher rate of non-resection cases, combined organ resections, positive marginal state, non-curatively treated case, and more postoperative complications. The prognosis of Borrmann type 4 gastric cancer was found to differ according to the type of operation, depth of invasion, nodal status, distant metastasis, and curability (P=0.0000) from the univariate survival analysis. No independent prognostic factor was found from the multivariate survival analysis. CONCLUSION: The majority of Borrmann type 4 gastric cancer are diagnosed at a late stage, which results in a poor prognosis. To improve the curability of the operation, combined organ resection should be considered, when feasible. There were no long-term survivors in the cases with peritoneal seeding or malignant ascites. It is for these cases that we have to exert our efforts, in order to improve their QOL, but not from over-surgery or intensive chemotherapy.

Comparative Studies on Clinicopathologic Characteristics and surgical Results in Senile and Young Patients with Gastric Cancer

The diagnosis of gastric cancer in young age group was sometimes missed .The operative risk in senile age group was high because of combined other organ diseases. We tried to determine the difference in their correct clinicopathologic features and the prognosis of young and senile patients with gastric cancer. Clinicopathologic characteristics and surgical results were compared in 40 senile gastric cancer patients who were aged 65 years or above, and in 48 young gastric cancer patients who were aged 40 years or less. In clinicopathologic features, the senile group was characterized by a high incidence of well differentiated adenocarcinoma and intestinal type by Lauren classification. The young age group was characterized by high incidence of undifferentiated type adenocarcinoma and diffuse type by Lauren classification . The others were unremarkable. When the survival rate was compared in all cases between young and senile group, the young age group showed a more favorable prognosis than the senile group, but without statistical difference ( P=0.0058 ) . Also, the survival rate according to UICC stage showed no statistical difference when the same stage of the two different groups were compared . Both group showed better survival in curative surgery cases than in noncurative surgery cases.Our findings ruled out any relationships between age and length of survival time in patients undergoing curative gastrectomy for gastric cancer.