The Clinical Research About Borrmann Typing Of Advanced Gastric Carcinoma(Clinical Analysis Of1699Cases)

Objective: According to Borrmann typing to analysis the clinicalcharacteristics of advanced gastric carcinoma to discuss the relationshipbetween general type and clinical biological behavior of advanced gastriccarcinoma, guide the clinical treatment.Methods: Clinical datas of1699cases were collected which fittedthe standards of advanced gastric cancer. The patients were in hospitalized in the forth hospital of hebei medical university from January of2007to December of2010. Some factors were analysed, such as the morbidity situation (age, gender), symptoms, signs, history of smoking, drinking history, complications (obstruction,bleeding,perforation),family historyof tumor, auxiliary examination, tumor position, size, pathology typeset,degree of differentiation, depth of invasion, surgery properties, kind ofsurgery, pTNM, lymph node metastasis, adjacent organ tissue invasion metastasis. Statisticsed by SPSS19.0, P<0.05was meaningful. After statistics and analysis, the biological behavior and surgical treatment of advanced gastric carcinoma were studied.Results:1The general form of advanced gastric carcinoma(Borrmann typing)There were1699patients operated. Among them, Borrmann type I74cases, II551cases, III845cases, IV218cases, V11cases. Borrmann III andBorrmann II was higher than other types in the group of advanced gastriccarcinoma, up to82.2%,and Borrmann I, V was little.2The Pathogenesis about Borrmann typing of advanced gastriccarcinoma:They were1294cases of male,405cases of female with ratio of 3.19:1. The ratio of male in Borrmann type I, II, III was higher thanIV,(P<0.05). The average age of this data was61.14±9.889,59.92±10.158,58.58±10.698,55.97±11.578,53.55±18.452.97patients had family history of tumor.595patients had Smoking history.348patients had drinking history.3The symptoms and signs of Borrmann typing of advanced gastriccarcinoma:3.1Symptom: bellyache,857patients, epigastric discomfort,759patients, abdominal distension,594patients, sour regurgitation,494patients, weight loss,456patients, heartburn,397patients, vomiting,308patients, nausea,303patients, belching,297patients, melena265patients, poor appetite,258patients, eating discomfort,204patients, singultus,146patients,acratia,117patients, hematemesis,61patients. Among the total, Borrmann IV comparing other types always occur loss of appetite, weight lossor weight loss, nausea, vomiting,(P<0.05).3.2Sign: upper abdominal tenderness,670patients, alpable mass,38patients, Virchow lymph node metastasis,72patients, anus heck,35patients. Upper abdominal tenderness was common in each type of Borrmann.At last some distant metastasis symptoms such as anal examinations positive,left clavicle lymph node positive existed.3.3patients with advanced gastric cancer complicated by pyloricobstruction,205patients, and182patients with hemorrhage, with perforatedgastric cancer,5patients. The bleeding rate of Borrmann IV was lower thanother types,(P<0.05).4Diagnosis: The diagnosis of gastroscope and pathology was98.7%; Thedetection rate of X-rays was95.5%. The detection rate of CT for gastriccarcinoma was94.8%. The detection rate of B ultrasound for gastriccarcinoma was7.0%.5The pathology typeset of Borrmann typing of advanced gastric carcinoma: 5.1Tumor position: carcinoma of the stomach bottom,561cases,carcinoma of the body of the stomach,478cases, carcinoma of gastricantrum ministry,443cases,full stomach cancer,217cases. Borrmann Iwas commonly found in the cardia of the stomach bottom and the body of the stomach.Borrmann II III was commonly found in the cardia of the stomach bottom, the body of the stomach and gastric antrum ministry. Borrmann IV V was commonly the full stomach cancer,(P<0.05).5.2Size: There were489patients whose diameter was <5cm, and1210patients whose diameter was≥5cm. The tumor diameter of each type ofBorrmann was often seen larger than5cm.5.3Infiltration depth: There were124patients whose tumour infiltratesmuscular layer,176patients whose tumour infiltrates serosa,1399patientswhose tumour infiltrates out of serosa. Borrmann IV invaded serosa moreeasily than I, II. The ratio of invasion and serosal layer of Borrmann IV washigher than that of Borrmann type III,(P<0.05).5.4postoperative pathology of advanced gastric cancer:1437casesof adenocarcinoma. squamous cell carcinoma,10cases.43cases of undifferentiated carcinoma. mucinous carcinoma,97cases.35case of small cell carcinoma. signet ring cell carcinoma,77cases. Adenocarcinomawas common in each type of Borrmann. The ratio about undifferentiated cancer of Borrmann IV was higher than other types,(P<0.05).5.5Histomorphological types: low differentiated type,906cases.moderately differentiated,783cases. high differentiation,10cases. BorrmannI was often seen of moderately differentiated. Borrmann II, III type was oftenseen of low differentiated and moderately differentiated. Borrmann IV, Vtype was often seen of low differentiation type,(P<0.05).5.6Lymph node metastasis:Borrmann I,63.5%. Borrmann II,68.1%.Borrmann III,80.1%. Borrmann IV,84.1%. Borrmann V,100%. By statistical analysis, Borrmann III IV compared with I II were more susceptible to lymph node metastasis,(P<0.05).5.7Penetration and tissues and organs: There were391patients whosetumour infiltrates adjacent tissues. liver metastasis,69cases. ovarian metastasis,9people. peritoneal seeding,138people. Hydroperitoneum,129people. Borrmann type IV, V comparing other types always invadedsurrounding organs and peritoneal and ascites was often seen when it was inoperation,(P<0.05).6TNM staging: I staging,55patients. II staging,346patients. IIIstaging,956patients. IV staging,342patients. The TNM staging of Borrmann I II IIIwas always stage III. The TNM staging of Borrmann IV was always stage IV,(P<0.05).7Operation status:7.1Property of operation: adical resection,1301cases. palliativeresection,398cases. The rate of adical resection in Borrmann I II III washigher than Borrman IV, V,(P<0.05).7.2Kind of surgery: the proximal stomach resection,356cases. distalgastrectomy,607Cases. the stomach,675cases. others,61cases. Totalgastrectomy was often choosen in treating Borrmann type IV comparing othertypes,(P<0.05).Conclusion:1Borrmann type III,II were often seen in the group of advanced cancer.2There was no relationship between Borrmann typing and family history of tumor.3Borrmann IV always occur loss of appetite, weight loss, nausea,vomiting.4The bleeding rate of Borrmann IV was lower than other types.5Borrmann IV V was commonly the full stomach cancer.6The tumor diameter of each yype of Borrmann was often seen larger than5cm.7Borrmann IV invaded serosa more easily than I, II.8The ratio about undifferentiated cancer of Borrmann IV was higherthan other types.9Borrmann IV, V type was often seen of low differentiation type.10Borrmann III IV compared with I II were more susceptible to lymph node metastasis.11Borrmann type IV, V comparing other types always invadedsurrounding organs and peritoneal and ascites was often seen when itwas in operation.12The rate of adical resection in Borrmann I II III was higher thanBorrman IV, V.13Total gastrectomy was often choosen in treating Borrmann type IVcomparing other types.