Qingyu Lin, Zikang Li, Wei Tang, Jianqiu Liu, Chanyan Huang, Ran Wei, Tianhao Zhang, Yan Qian, Yin Li, Jianhui Chen, Shirong Cai, Jinning Ye, Ertao Zhai
Bor-IV is characterized by distinctive imaging features and an exceptionally poor prognosis that is not fully captured by conventional TNM staging. Bor-IV may represent a clinically aggressive phenotype within advanced gastric cancer, underscoring the need for refined risk stratification and optimized multimodal treatment strategies in future prospective studies.
BACKGROUND: Borrmann type IV gastric cancer (Bor-IV) is clinically recognized as an aggressive phenotype; however, its prognostic burden relative to contemporary TNM staging and its radiological correlates remain incompletely characterized.
METHODS: We retrospectively analyzed 1236 patients with advanced gastric adenocarcinoma who underwent radical gastrectomy, including 124 Bor-IV and 1112 Non Bor-IV cases. Clinicopathological features, multimodal imaging characteristics, and survival outcomes were compared. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier methods and Cox proportional hazards models.
RESULTS: Among 1236 patients, 124 (10.03%) were Bor-IV and 1112 (89.97%) were Non Bor-IV. Bor-IV was associated with more advanced T stage, N stage, pathological stage, larger tumor size, and a higher proportion of signet-ring cell components (all p < 0.001). Multivariate Cox regression analysis confirmed Bor-IV as an independent prognostic factor for poor OS after adjusting for TNM and other clinicopathological factors (HR = 3.837, 95% CI: 2.900-5.080, P < 0.001). Patients with Bor-IV had a median OS of 21.3 months and a 5-year OS rate of 20.24%, significantly worse than Non Bor-IV across all pathological stages, T stages, and N stages. Notably, the survival of Bor-IV patients approached that of stage IV disease. In the Bor-IV subgroup, age > 60 years and advanced T stage were independent predictors of poor OS. Among treatment modalities, only R0 resection was significantly associated with improved DFS and OS.
CONCLUSIONS: Bor-IV is characterized by distinctive imaging features and an exceptionally poor prognosis that is not fully captured by conventional TNM staging. Bor-IV may represent a clinically aggressive phenotype within advanced gastric cancer, underscoring the need for refined risk stratification and optimized multimodal treatment strategies in future prospective studies.