Yang Bin, Wu Guoqiang, Wang Xiaochen, Zhang Xuefeng
Department of General Surgery, The 210th Hospital of PLA, Dalian, 116021, China.
Tumour Biol. 2013 Jun;34(3):1485-91. doi: 10.1007/s13277-013-0673-7. Epub 2013 Feb 13.
This study aims to investigate the prognostic significance of reclassification of stage IV gastric cancers in conjunction with Borrmann type. A total of 1,673 gastric cancer patients who received a gastrectomy between 1980 and 2003 were retrospectively evaluated. Of the patients, 244 (14.58 %), 344 (20.56 %), 589 (35.21 %), and 496 (29.65 %) had stage I, II, III, and IV cancers, respectively. After Cox regression analysis, Borrmann type was identified to be the independent prognostic factor in stage IV gastric cancer. The disease-specific postoperative survival of patients with Borrmann I, II, and III tumors was clearly distinguished by TNM classification system (P<0.05), while it failed to classify Borrmann IV tumors (P=0.147). Interestingly, the disease-specific postoperative survival of stage IV patients with Borrmann IV tumors (group 1) was significantly poor than the cases with stage IV but not Borrmann IV tumors (group 2), as well as the patients with Borrmann IV while not included in stage IV tumors (group 3) (P=0.022 and P=0.000, respectively). Meanwhile, the disease-specific postoperative survival was not observed as significantly different between group 2 and group 3 (P=0.063); furthermore, group 2+3 had a better prognosis than group 1 (introduced stage IVa vs. stage IVb; P=0.006). Reclassification of stage IV through combining the present TNM classification system with Borrmann type may more accurately predict the prognosis of patients.
本研究旨在探讨Ⅳ期胃癌重新分类结合Borrmann分型的预后意义。对1980年至2003年间接受胃切除术的1673例胃癌患者进行回顾性评估。其中，分别有244例（14.58%）、344例（20.56%）、589例（35.21%）和496例（29.65%）患者患有Ⅰ、Ⅱ、Ⅲ和Ⅳ期癌症。经Cox回归分析，Borrmann分型被确定为Ⅳ期胃癌的独立预后因素。TNM分类系统能明确区分BorrmannⅠ、Ⅱ和Ⅲ型肿瘤患者的疾病特异性术后生存率（P<0.05），而对BorrmannⅣ型肿瘤则无法进行分类（P=0.147）。有趣的是，BorrmannⅣ型肿瘤的Ⅳ期患者（第1组）的疾病特异性术后生存率显著低于非BorrmannⅣ型的Ⅳ期患者（第2组）以及未纳入Ⅳ期肿瘤的BorrmannⅣ型患者（第3组）（分别为P=0.022和P=0.000）。同时，第2组和第3组之间的疾病特异性术后生存率无显著差异（P=0.063）；此外，第2组+第3组的预后优于第1组（重新分类为Ⅳa期与Ⅳb期；P=0.006）。通过将现行TNM分类系统与Borrmann分型相结合对Ⅳ期进行重新分类，可能更准确地预测患者的预后。
