Lauren Histology and Lymphatic Permeation are Critical Prognostic Factors in Borrmann Type I Gastric Cancer

Abstract

Macroscopic Borrmann type I is relatively rare in advanced gastric cancer, and its detailed prognostic traits are unknown. Among 5172 gastric cancer patients between 1971 and 2013, 114 cases with macroscopic Borrmann type I were identified (2.2%), among which 112 displayed clinicopathologic factors. Univariate prognostic factors with statistical significance were initially selected, which were further applied to the multivariate proportional hazards model. Recently, postoperative adjuvant chemotherapy was recommended for stage II/III gastric cancer patients. Results were as follows: (1) Five-year overall survival (OS) was 66% in Borrmann type I gastric cancer. Five-year relapse-free survival (RFS) was 100%, 87.1%, and 65.5% in stage IA, stage IB, and stage II/III, respectively. (2) Multivariate proportional hazard model for OS identified lymphatic permeation [hazard ratio (HR) = 4.8–7.5, P = 0.0021] and age (HR = 2.4, P = 0.026), while the multivariate analysis for RFS identified histology (HR = 3.5, P = 0.018) and lymphatic permeation (HR = 3.5–4.7, P = 0.049) as independent prognostic factors. (3) Recurrence was recognized more in liver of the intestinal type histology. Diffuse type histology with robust lymphatic invasion was all attributed to stage II/III, which occurred largely within 1 year and exhibited 49% RFS. Recurrence pattern of Borrmann Type I gastric cancer with intestinal type histology is unique, and patients with high risk for recurrences were enriched in diffuse type histology with robust lymphatic invasion.