Borrmann Type IV 위암의 특성과 예후인자

Abstract

Borrmann type IV gastric cancer diffusely infiltrates and thickens the wall of the stomach without forming conspicuous protrusions or ulcerations. This particular type of gastric cancer is usually diagnosed in an advanced stage and the results of treatment have been disappointing. To evaluate the clinicopathological characteristics of Borrmann type IV gastric cancer and to determine the prognostic factors, we analyzed retrospectively 1,503 patients with advanced gastric cancer who underwent gastric resection between 1987 to 1993 at Department of Surgery, Yonsei University, College of Medicine. Among them, 156 patients (10.4%) had Borrman type IV gastric cancer. These patients tended to be younger and female and to have larger tumors that involved the middle third portion and entire stomach as compared with patients with other types of gastric cancer. Borrmann type IV gastric ccancer had higher rates of dedifferentiated tissue(91.0%), serosal invsion(89.8%), lymph nodes metastasis985.9%) and peritoneal metastasis(13.5%) than other types of gastric cancer. In most instances(83.4%), the disease was advanced above TNM stage III. Total gastrectomy was performed upon 57.1% of the patients and palliative resection was done in 25.0%. The 5-year survival rate of type IV patients was 26.6% and was lower than for patients with other types of gastric cancer. The significant prognostic factors by multivariate analysis were lymph node metastasis and peritoneal metastasis. These results suggest that early detection and curative resection of this cancer are crucial to extend survival time of patients with type IV gastric cancer and aggressive multimodal therapies including early postoperative intraperitoneal chemotherapy or intraperitoneal hyperthermic chemotherapy should be considered when a palliative resection is done.