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
Gastric cancer (GC) is an important public health burden worldwide. 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. Many studies have shown that Borrmann type and lymphatic and/or blood vessel invasion (LBVI) are independent risk factors for the prognosis of patients with advanced gastric cancer, but few studies have analyzed the prognostic significance of the combination of the two indexes in patients with advanced gastric cancer.
Analyzing whether Borrmann type combined with LBVI has prognostic significance for advanced gastric cancer will provide a basis for clinicians to treat and predict the prognosis of these patients in the future.
To evaluate the significance of Borrmann type combined with LBVI status in evaluating the prognosis of advanced gastric cancer.
This retrospective study analyzed the clinicopathological characteristics and long-term survival data of 2604 patients with advanced gastric cancer, all of whom were diagnosed with advanced gastric adenocarcinoma at the Affiliated Tumor Hospital of Harbin Medical University from 2009 to 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.
This retrospective study included a total of 2604 patients. The results showed that the 5-year survival rate of Borrmann types I-IV patients was significantly different (P < 0.001), and the 5-year survival rate of patients with LBVI (+) was significantly lower than that of LBVI (-) patients. When we combined Borrmann type 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 type IV disease and LBVI (-) (16.4% vs 13.1%, P = 0.065) or LBVI (+) (16.4% vs 11.2%, P = 0.112). Subgroup analysis showed that the above results were true in any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann type (P = 0.023), LBVI (P < 0.001), tumor size (P = 0.012), pT staging (P < 0.001), pN stage (P < 0.001), and extent of radical surgery (P < 0.001) are independent prognostic factors.
Borrmann type, LBVI status, tumor size, pT stage, pN stage, and extent of radical surgery all independently affect prognosis. Patients with Borrmann type III disease and LBVI (+) have a similar 5-year survival rate to those with Borrmann type IV disease and LBVI (-) or LBVI (+)
We recommend that clinicians should formulate a comprehensive multidisciplinary, multimodal, and individualized treatment plan when they encounter patients with Borrmann type III GC and LBVI (+), regardless of the pT stage and tumor location, to obtain better survival results.