Type-Specific Diagnosis and Evaluation of Longitudinal Tumor Extent of Borrmann Type IV Gastric Cancer: CT versus Gastroscopy

OBJECTIVE: To compare the accuracy of computed tomography (CT) with that of gastroscopy for the extent of evaluation of longitudinal tumor and type-specific diagnosis of Borrmann type IV gastric cancer. MATERIALS AND METHODS: Fifty-nine patients (35 men with mean age of 60 years and 24 women with mean age of 55 years) who underwent surgical resection of Borrmann type IV gastric cancer were included in this study. Histopathological analysis data was used as a reference standard to confirm the clinical interpretations of gastroscopy and CT for the diagnosis of Borrmann type IV and evaluation of longitudinal tumor extent. For the evaluation of longitudinal extent, gastroscopic and CT results were classified as underestimated, accurate, or overestimated. The McNemar test was used to identify statistically significant differences in the accuracy between gastroscopy and CT. RESULTS: For the diagnosis of Borrmann type IV gastric cancer, the accuracy of CT was significantly higher than that of gastroscopy (74.6% [44/59] vs. 44.1% [26/59], p < 0.001). CT was significantly more accurate in assessing the overall tumor extent than gastroscopy (61.4% [35/57] vs. 28.1% [16/57], p < 0.001). The proximal (75.4% [43/57] vs. 50.9% [29/57], p = 0.003) and distal tumor extent (71.9% [41/57] vs. 43.9% [25/57], p < 0.05) were more accurately predicted by CT compared with gastroscopy. The underestimation of tumor extent was a major source of error in both examinations. CONCLUSION: CT was found to be more predictive than gastroscopy in type-specific diagnosis and the evaluation of longitudinal tumor extent in patients with Borrmann type IV gastric cancer.

An Insufficient Preoperative Diagnosis of Borrmann Type 4 Gastric Cancer in Spite of EMR

Borrmann type 4 gastric cancers are notorious for the difficulty of finding cancer cells in the biopsy samples obtained from gastrofiberscopy. It is important to obtain the biopsy results for making surgical decisions. In cases with Borrmann type 4 gastric cancer, even though the radiological findings (such as an upper gastrointestinal series, abdominal computed tomography and positron emission tomography/computed tomography) or the macroscopic findings of a gastrofiberscopy examination imply a high suspicion of cancer, there can be difficulty in getting the definite pathologic results despite multiple biopsies. In these cases, we have performed endoscopic mucosal resection under gastrofiberscopy as an alternative to simple biopsies. Here we report on a case in which no cancer cells were found even in the endoscopic mucosal resection specimen, but the radiologic evidence and clinical findings were highly suspicious for gastric cancer. The patient finally underwent total gastrectomy with lymph node resection, and she was pathologically diagnosed as having stage IV gastric cancer postoperatively.

Clinicopathological Features of Borrmann Type IV Gastric Carcinomas

PURPOSE: The prognosis of Borrmann type IV gastric cancer is poorer than that of the other gastric carcinomas. We compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of cancer and analyzed the significance of a Borrmann type IV carcinoma as a prognostic factor. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathologic features, TNM stage and survival rates of 4,389 gastric cancer patients who received surgical management at Samsung Medical Center between January 1995 and December 2004. RESULTS: Patients with a Borrmann type IV gastric carcinoma had a more advanced stage than patients with other types of gastric carcinomas at the initial diagnosis, and the curative resection rate was lower. The 5-year survival rate of patients with Borrmann type IV cancer was 20.7%, and that of patients with other types of cancer was 50.3%. The 5-year survival rate of patients with Borrmann type IV gastric carcinomas was significantly lower than that of patients with other types of gastric carcinomas at the same TNM stage. In univariate and multivariate analyses, the depth of invasion, the nodal state, distant metastasis, the TNM stage, curability and the presence of a Borrmann type IV carcinoma were independent prognostic factors in cases of gastric cancer. CONCLUSION: Compared to the other types of gastric carcinomas, a Borrmann type IV carcinoma has unique clinicopathological features. The prognosis should be predicated considering the differences between Borrmann type IV gastric carcinomas and other types of gastric carcinomas, and multimodal and intensive therapies are needed in patients with a Borrmann type IV gastric carcinoma.

Clinicopathologic Characteristics of and Prognosis for Patients with a Borrmann Type IV Gastric Carcinoma

PURPOSE: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. MATERIALS AND METHODS: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. RESULTS: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). CONCLUSION: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup.

Clinicopathological Analysis of Borrmann Type IV Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Borrmann type IV gastric cancer is often diagnosed only at an advanced stage, resulting in a prognosis poor. We performed a retrospective study of the clinical characteristics of Borrmann type IV gastric cancer and the prognostic factors affecting the survival rate in such patients. MATERIALS AND METHODS: Of 4, 063 patients with all gastric cancers, 370 (9%) with Borrmann type IV gastric cancer were analyzed. RESULTS: The clinical characteristics of these patients included a higher incidence rate in young females, and higher rates of serosa exposure, metastasis to lymph nodes and early peritoneal dissemination. Of patients presenting with peritoneal seeding, those resected had a higher survival rate than those that were not. A univariate analysis showed that the prognostic factors affecting the survival rate following a curative resection were the location, occupied area and depth of the primary tumor, as well as the presence of lymph node metastasis and the tumor stage. A multivariate analysis indicated that the tumor location and stage were significant independent prognostic factors after a curative resection for Borrmann type IV gastric cancer. CONCLUSION: In conclusion, the early diagnosis and treatment of patients with Borrmann type IV gastric cancer are essential for the better survival of these patients. Even in patients with advanced tumors, a noncurative palliative resection may improve the prognosis.

Expression of E-cadherin and CD44H in Borrmann Type IV Gastric Cancer

PURPOSE: E-cadherin and CD44H have been shown to play a role in the progression and the metastasis of tumors. This study evaluated the clinical correlations between expression of E-cadherin and CD44H and various clinicopathologic factors and the value of expressions of E-cadherin and CD44H as prognostic factors in Borrmann type IV gastric cancer. MATERIALS AND METHODS: In 122 patients with Borrmann type IV gastric cancer, we performed the immunohistochemical stainings for E-cadherin and CD44H. We analyzed the correlation between the expressions of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, stage, and peritoneal dissemination, and survival. RESULTS: There were no correlations between reduced expression of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, and stage. However, there was a significant correlation between lymph node metastasis and the lymphatic invasion (P=0.022). There was also a significant correlation between the peritoneal dissemination and CD44H expression (P=0.005). The 5-year survival rate was correlated with CD44H expression (P=0.026), peritoneal dissemination (P<0.01), depth of invasion (P<0.01), lymph node metastasis (P<0.01), stage of tumor (P<0.01), and lymphatic invasion (P<0.01). There was no correlation between expression of E-cadherin and survival rate. CONCLUSION: The expression of CD44H and peritoneal dissemination was correlated. The expression of CD44H was an independent prognostic factor in Borrmann type IV gastric cancer. Further prospective studies with a large number of cases are required.