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Liang C, Chen G, Zhao B, Qiu H, Li W, Sun X, Zhou Z, Chen Y. Borrmann Type IV Gastric Cancer: Focus on the Role of Gastrectomy. J Gastrointest Surg 2020; 24:1026-1032. [PMID: 31090037 DOI: 10.1007/s11605-019-04236-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/16/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The benefits of curative or palliative gastrectomy for Borrmann type IV (B-IV) gastric cancer remain controversial. This study was conducted to investigate whether or not gastrectomy could benefit prognosis of patients with Borrmann type IV gastric cancer. MATERIAL AND METHODS A cohort of 469 B-IV gastric cancer patients from January 2001 to September 2017 was retrospectively reviewed. Survival analysis was used to investigate the prognosis of patients with or without gastrectomy. RESULTS Among this cohort, the average age was 55 years and the median follow-up time was 12 months. One hundred and forty-six (31%) patients underwent curative resection, 187 (40%) patients underwent palliative resection, and the remaining 136 (29%) patients were judged unresectable. During the follow-up, a total of 294 (63%) patients died. Cox multivariate analysis showed that Tumor Node Metastasis (TNM) stage (p = 0.002), grade (p = 0.033), and gastrectomy (p < 0.001) were independent predictors of overall survival. Kaplan-Meier analysis revealed that, no matter in total group or subgroup stratified by tumor stage and grade, overall survival rates at 1 year, 2 years, and 5 years in patients with palliative resection were significantly worse than those in patients with curative resection (all p < 0.05), but significantly better than those in patients with no resection (all p < 0.05). CONCLUSIONS Curative or palliative gastrectomy could increase the survival rate for B-IV gastric cancer patients. In the absence of alternative effective therapies, surgical resection remains a choice of improved survival or potential cure for B-IV gastric cancer.
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Affiliation(s)
- Chengcai Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Guoming Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Baiwei Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Haibo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiaowei Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhiwei Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yingbo Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,, Guangzhou, China.
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Zhu FQ, Chu HJ, Gong ZH, Du FC, Chen J, Jiang LX. Undiagnosed Borrmann type IV gastric cancer despite repeated endoscopic biopsies and PET-CT examination: A case report. Oncol Lett 2016; 12:1485-1488. [PMID: 27446457 PMCID: PMC4950615 DOI: 10.3892/ol.2016.4763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/12/2016] [Indexed: 12/23/2022] Open
Abstract
Borrmann type IV gastric cancer is a particular histological type of carcinoma, which has the characteristic of diffused infiltration that invades the entire stomach, resulting in the thickening and stiffness of the stomach wall. Borrmann type IV gastric cancer is known for the difficulty of detecting tumor cells in endoscopic biopsy specimens. This is crucial in obtaining the pathological results to make a therapeutic decision. The case reported in the present study was highly suspected to be Borrmann type IV gastric cancer according to the clinical manifestations and gastrointestinal barium meal examinations, but demonstrated negative results in multiple endoscopic biopsies and positron emission tomography-computed tomography (PET-CT) examination. The patient was discharged as no affirmative diagnosis was specified. Two weeks after discharge, the patient was administered to another hospital under emergency treatment due to frequent urination. Cystoscopy examination revealed marked thickening of the right bladder wall over a large area. Biopsy specimens were sampled. Pathological consultation suggested a gastrointestinal original of the lesion, which was most likely poorly differentiated gastric adenocarcinoma with neuroendocrine metastasis to the bladder.
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Affiliation(s)
- Fang-Qing Zhu
- First Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China; First Clinical College, Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Hong-Jin Chu
- Central Laboratory, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Zhao-Hua Gong
- Second Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Feng-Cai Du
- First Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China; First Clinical College, Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Jian Chen
- First Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China; Central Laboratory, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Li-Xin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Yan C, Bao X, Shentu W, Chen J, Liu C, Ye Q, Wang L, Tan Y, Huang P. Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1431-1440. [PMID: 27072076 DOI: 10.1016/j.ultrasmedbio.2016.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/25/2015] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ(2), p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ(2), p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.
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Affiliation(s)
- Caoxin Yan
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xiaofeng Bao
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Weihui Shentu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jian Chen
- Department of Surgery, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Chunmei Liu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Qin Ye
- Department of Pathology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Liuhong Wang
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Yangbin Tan
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
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Limited significance of curative surgery in Borrmann type IV gastric cancer. Med Oncol 2016; 33:69. [PMID: 27251378 DOI: 10.1007/s12032-016-0783-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/22/2016] [Indexed: 12/23/2022]
Abstract
Borrmann type IV advanced gastric cancer has a poor prognosis. Although surgical resection remains the only hope for a cure, the role of curative surgery is questionable in this type of cancer. This study defined the role of curative surgery in the prognosis of type IV gastric cancer. We analyzed 168 patients with Borrmann type IV undergoing surgery at Seoul St. Mary's Hospital from 1989 to 2010. We categorized the patients into curative (R0) and non-curative (R1, R2, and non-resection) groups. The curative and non-curative groups comprised 88 and 80 patients, respectively. The preoperative predictive value of Borrmann type IV was 50.5, and 8.9 % of the patients had microscopic resection margin involvement. The 3- to 5-year overall survival (OS) of patients in the curative group was significantly higher than that of in the non-curative group (p < 0.001). However, in a multivariate analysis, curability was not a significant predictor of survival (p = 0.187). In the curative group, the most frequent recurrence site was the peritoneum (85.7 %). Most recurrences occurred within 2 years. The role of surgery for Borrmann type IV is quite limited. Such cases have a poor prognosis even after curative surgery. In addition, microscopic resection margin involvement is frequent in type IV cancer because it is difficult to diagnose preoperatively. Therefore, multimodal diagnostic tools and treatment strategies should be developed for Borrmann type IV gastric cancer.
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Luo Y, Gao P, Song Y, Sun J, Huang X, Zhao J, Ma B, Li Y, Wang Z. Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis. World J Surg Oncol 2016; 14:49. [PMID: 26912240 PMCID: PMC4765022 DOI: 10.1186/s12957-016-0805-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/17/2016] [Indexed: 02/07/2023] Open
Abstract
Background The clinicopathologic features and surgical treatment strategy of Borrmann type IV (B-4) gastric cancer remains controversial. This meta-analysis was conducted to evaluate the clinicopathologic features of patients with B-4 gastric cancer and to assess whether or not non-curative resection improved prognosis. Methods PubMed and Embase were searched for relevant articles. Statistical analysis was performed using RevMan (version 5.2). The odds ratio (OR), risk ratio (RR), hazard ratio (HR) with 95 % confidence interval (CI), and weighted average of median survival times were calculated as effect values. Results Fifteen studies were included. Compared with Borrmann type “others” (B-O), B-4 had a higher incidence of poorly differentiated carcinoma (OR = 4.92; 95 % CI = 3.10–7.83; P < 0.01), lymph node metastases (OR = 2.13; 95 % CI = 1.88–2.41; P < 0.01), peritoneal metastases (OR = 3.91; 95 % CI = 3.37–4.54; P < 0.01), serosal invasion (OR = 3.66; 95 % CI = 2.91–4.60; P < 0.01), and lymphatic invasion (OR = 1.39; 95 % CI = 1.02–1.91; P = 0.04). B-4 patients with non-curative resection were associated with a worse survival rate (HR = 2.83; 95 % CI = 2.35–3.40; P < 0.01) than patients with curative resection; however, B-4 patients with non-curative resection had a better survival rate (1-year: RR = 0.70, 95 % CI = 0.63–0.77; P < 0.01; 2-year: RR = 0.90, 95 % CI = 0.85–0.94; P < 0.01) than patients with non-resection. Conclusions Our meta-analysis indicated that B-4 patients were associated with poor tumor differentiation, lymph node metastases, peritoneal metastases, serosal invasion, lymphatic invasion, and prognosis. Curative resection may increase the survival rate for B-4 patients. If it is not possible to perform a curative resection, a non-curative resection may improve the prognosis.
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Affiliation(s)
- Yifan Luo
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Yongxi Song
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Jingxu Sun
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Xuanzhang Huang
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Junhua Zhao
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Bin Ma
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Yuan Li
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
| | - Zhenning Wang
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China.
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Correlations between vascular invasion, neural structures invasion and microvessel density with clinicopathological parameters in gastric cancer. REV ROMANA MED LAB 2014. [DOI: 10.2478/rrlm-2014-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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