Published online Sep 15, 2020. doi: 10.4251/wjgo.v12.i9.992
Peer-review started: June 15, 2020
First decision: July 30, 2020
Revised: August 11, 2020
Accepted: August 31, 2020
Article in press: August 31, 2020
Published online: September 15, 2020
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.
To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer.
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 χ2 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.
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.
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.
Core Tip: Although the evolution of diagnostic methods has led to an increase in the diagnosis rate of early gastric cancer, most patients present with an advanced stage when they are diagnosed with gastric cancer. Comprehensive multimodal and multidisciplinary treatment systems, including chemotherapy and targeted therapy, are gradually improving. However, wise treatment choices must be made based on the clear clinical stage of the disease. Many studies have shown that Borrmann type and vessel invasion are independent risk factors for the prognosis of patients with advanced gastric cancer, but few studies have analyzed the prognostic signficance of the combination of the above two indexes in patients with advanced gastric cancer. Therefore, we analyzed whether Borrmann type combined with vessel invasion has prognostic significance in advanced gastric cancer, with an aim to provide a basis for clinicians to treat and predict the prognosis of these patients in the future.