Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer

BACKGROUND Borrmann classification (types I-IV) for the detection of advanced gastric cancer has been accepted worldwide, and lymphatic and/or blood vessel invasion (LBVI) status is related to the poor prognosis after gastric cancer. AIM To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer. METHODS We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013. Categorical variables were evaluated by the Pearson's chi(2) 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. RESULTS A total of 2604 patients were included in this study. The presence of LVBI [LBVI (+)] and Borrmann type (P= 0.001), tumor location (P< 0.001), tumor size (P< 0.001), histological type (P< 0.001), tumor invasion depth (P< 0.001), number of metastatic lymph nodes (P< 0.001), and surgical method (P< 0.001) were significantly correlated with survival. When analyzing the combination of the Borrmann classification 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 IV + LBVI (-) (16.4%vs13.1%,P= 0.065) and those with Borrmann IV + LBVI (+) (16.4%vs11.2%,P= 0.112). Subgroup analysis showed that the above results were true for any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann classification (P= 0.023), vascular infiltration (P< 0.001), tumor size (P= 0.012), pT stage (P< 0.001), pN stage (P< 0.001), and extent of radical surgery (P< 0.001) were independent prognostic factors for survival. CONCLUSION Since patients with Borrmann III disease and LBVI (+) have the same poor prognosis as those with Borrmann IV disease, more attention should be paid to patients with Borrmann III disease and LBVI (+) during diagnosis and treatment, regardless of the pT stage and tumor location, to obtain better survival results.