Borrmann's type IV gastric cancer: Clinicopathologic analysis

OBJECTIVE: To determine whether there is a specific pattern of clinicopatho logical features that could distinguish Borrmann's type IV gastric cancer f rom other types of gastric cancer. DESIGN: A retrospective study of patients with advanced gastric cancer trea ted between 1985 and 1995. SETTING: The Department of Surgery, Sendai National Hospital, a 716-bed tea ching hospital. PATIENTS: The clinicopathologic features of 88 patients with Borrmann's typ e TV carcinoma of the stomach were reviewed from the database of gastric ca ncer. The results were compared with those of 309 patients with other types of gastric carcinoma. MAIN OUTCOME MEASURES: Gender, age, tumour size, depth of invasion, histolo gic type, cancer-stromal relationship, histologic growth pattern, nodal inv olvement, lymphatic and vascular invasion, type of operation, cause of deat h and 5-year survival. RESULTS: Women were afflicted as commonly as men in the Borrmann's type IV group. These patients tended to be younger and to have larger tumours invol ving the entire stomach than patients with other types of cancer. Histologi c type was commonly diffuse and scirrhous, and serosal invasion was promine nt with infiltrative growth. Nodal involvement and-lymphatic invasion were more common in patients with Borrmann's type IV than in those with other ty pes of gastric cancer. The disease was advanced in most instances and a tot al gastrectomy was performed in 55% of the patients. The survival rate of p atients with Borrmann's type IV tumour was lower than for patients with oth er types of gastric cancer (p < 0.005, log rank test). CONCLUSIONS: In Borrmann's type TV gastric cancer, early detection and cura tive resection are crucial to extend the patient's survival. Aggressive pos toperative chemotherapy is recommended when a noncurative resection is perf ormed.