Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1325-1335
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1325
Subtotal gastrectomy combined with chemotherapy: An effective therapy for patients with circumscribed Borrmann type IV gastric cancer
Hai-Bo Huang, Zi-Ming Gao, An-Qi Sun, Wei-Tian Liang, Kai Li
Hai-Bo Huang, Zi-Ming Gao, An-Qi Sun, Wei-Tian Liang, Kai Li, Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Huang HB and Li K designed the research; Gao ZM and Li K treated the patients and collected the material and clinical data from the patients; Huang HB and Sun AQ performed the assays; Liang WT and Huang HB analyzed the data; Huang HB wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of First Affiliated Hospital of China Medical University.
Informed consent statement: Written informed consent was obtained from each patient.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement:  No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Li, PhD, Professor, Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Street, Shenyang 110001, Liaoning Province, China. cmu_likai@163.com
Received: July 26, 2020
Peer-review started: July 26, 2020
First decision: August 9, 2020
Revised: August 20, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: November 15, 2020
Abstract
BACKGROUND

Although Borrmann type IV (B-4) gastric cancer has a higher mortality rate and presents distant metastasis easily, especially peritoneal metastasis, when diagnosed, some B-4 patients were found to have no distant metastasis by preoperative detection and underwent curative surgery, which was defined as circumscribed B-4 in our study. In this study, we focused on the circumscribed B-4 patients without distant metastasis during surgery to identify factors related to prognosis and postoperative peritoneal cavity metastasis (PPCM), which is important for selecting an appropriate therapeutic strategy.

AIM

To identify factors related to the prognosis and PPCM of B-4 patients.

METHODS

A total of 117 B-4 patients who underwent gastrectomy between January 2005 and December 2012 were included in this study. Survival analysis was performed using Kaplan–Meier analysis and Cox multivariate models. Pearson correlation analyses were performed to identify the factors related to PPCM. All statistical analyses were performed using SPSS 20.0.

RESULTS

Lymph node status, gastrectomy type, and postoperative chemotherapy were independent prognostic factors in 117 circumscribed B-4 patients. Subtotal gastrectomy combined with chemotherapy could significantly improve the long-term survival time. Six patients who were diagnosed with pN0 and received the combination therapy had a 3-year survival rate of 100% and a median survival of 77.7 mo. Even for patients with metastatic lymph nodes (n = 13), the combination therapy also increased the 3-year overall survival rate to 57.1%. In addition, positive lymph node status was the only factor (P = 0.005) correlated with PPCM in certain B-4 patients, and chemotherapy was useful for suppressing PPCM in patients with subtotal gastrectomy but not in those with total gastrectomy.

CONCLUSION

Lymph node status is an independent prognostic factor for circumscribed B-4 patients. In addition, subtotal gastrectomy and postoperative chemotherapy could effectively improve prognosis and even suppress PPCM.

Keywords: Gastric cancer, Circumscribed, Borrmann type IV, Prognosis, Subtotal gastrectomy, Chemotherapy

Core Tip: This is a retrospective study to evaluate the factors related to prognosis and prognostic postoperative peritoneal cavity metastasis for circumscribed Borrmann type IV (B-4) patients. We reported that lymph node metastatic status, gastrectomy type, and postoperative chemotherapy were the independent prognostic factors. Subtotal gastrectomy combined with chemotherapy could significantly improve the long-term survival time of circumscribed B-4 patients. And chemotherapy was also useful for suppressing postoperative peritoneal cavity metastasis in patients with subtotal gastrectomy. We believe that our study makes a significant contribution to the literature because it recommended reasonable treatment schedules for the B-4 patients, which can increase survival time to a certain extent.