Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2019; 11(8): 642-651
Published online Aug 15, 2019. doi: 10.4251/wjgo.v11.i8.642
Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer
Shan Gao, Guo-Hui Cao, Peng Ding, Yang-Yang Zhao, Peng Deng, Bin Hou, Kai Li, Xiao-Fang Liu
Shan Gao, Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Guo-Hui Cao, The first department of oncology, Hebei general Hospital, Shijiazhuang, Hebei Province 050051, China
Peng Ding, Peng Deng, Bin Hou, Kai Li, Xiao-Fang Liu, Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Yang-Yang Zhao, School of Public Health, China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Gao S, Zhao YY and Deng P collected the data and drafted the manuscript; Cao GH, Ding P and Hou B analyzed the data; Liu XF and Li K designed and supervised the study.
Supported by the Foundation of Innovative Talents in Higher Education of Liaoning Province, No. LR2016043.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of China Medical University.
Informed consent statement: Patients were not required to give informed consent as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by providing written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Corresponding author: Xiao-Fang Liu, MD, PhD, Doctor, Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang 110001, Liaoning Province, China.
Telephone: +86-24-83282821
Received: May 21, 2019
Peer-review started: May 21, 2019
First decision: July 16, 2019
Revised: July 18, 2019
Accepted: August 3, 2019
Article in press: August 3, 2019
Published online: August 15, 2019
Research background

Lymphatic and/or blood vessel invasion (LBVI) plays an important role in tumor cell dissemination and metastasis during tumor progression, which contributes to the poor prognosis of patients with gastric cancer.

Research motivation

The Borrmann classification is generally assigned based on macroscopic examination of the tumor, although some Borrmann type III tumors have a similar appearance and prognosis to Borrmann type IV tumors, which has led to the term “limited Borrmann type IV”. Previous studies have indicated that Borrmann type IV disease has a very poor prognosis.

Research objectives

In this study, the authors aim to evaluate the prognostic significance of LBVI combined with the Borrmann type in advanced proximal gastric cancer (APGC).

Research methods

The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.

Research results

In these 440 patients, LBVI+ status was associated with Borrmann type IV, low histological grade, large tumor size, and advanced pT and pN status. The 5-year survival rate of LBVI+ patients was significantly lower than that of LBVI– patients, although LBVI was not an independent prognostic factor in the multivariate analysis. No significant difference in the prognosis of patients with Borrmann type III/LBVI+ disease and patients with Borrmann type IV disease was observed. Therefore, we proposed a revised Borrmann type IV (r-Bor IV) as Borrmann type III plus LBVI+, and found that r-Bor IV was associated with poor prognosis in patients with APGC, which outweighed the prognostic significance of pT status.

Research conclusions

LBVI status may help clarify the difference between Borrmann type III and IV tumors. Based on our revised classification, we suggest that patients with (r-Bor IV APGC should be treated the same as patients with standard Borrmann type IV APGC.

Research perspectives

In patients with pT3 and pT4a APGC, r-Bor IV could be used to guide prognostication and follow-up treatment.