Clinicopathologic Characteristics of Borrmann Type 4 Gastric Cancer

ABSTRACT

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.