Published online Aug 15, 2019. doi: 10.4251/wjgo.v11.i8.642
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
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.
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.
In this study, the authors aim to evaluate the prognostic significance of LBVI combined with the Borrmann type in advanced proximal gastric cancer (APGC).
The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.
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.
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.
In patients with pT3 and pT4a APGC, r-Bor IV could be used to guide prognostication and follow-up treatment.