title: Survival outcome of Borrmann type IV gastric cancer potentially improved by multimodality treatment.
abstract: BACKGROUND
  Type IV macroscopic gastric cancer has the poorest prognosis of all gastric cancer types. Although progress of multidisciplinary treatments is outstanding, the current survival outcome of such therapies is obscure.
  
  
  METHODS
  Among 5,172 patients with gastric cancer between 1971 and 2013, 287 cases of type IV were identified (5%). We divided time period into early (1971-2004) and late periods (2005-2013), and compared their prognosis. Multivariate Cox proportional hazards model was applied to the univariate prognostic factors, and identified independent prognostic factors and long-term survivors.
  
  
  RESULTS
  Five-year overall survival (OS) was 13% and 31% in the early and late periods, respectively (p=0.0010). Univariate prognostic factors were age, pathological tumor depth of invasion (pT), pathological lymph node metastasis (pN), peritoneal dissemination (P), intra-peritoneal cytology test (CY), and margin status. Multivariate analysis determined independent prognostic factors to be treatment period (p=0.0001), pT (p=0.0024) and P (p=0.035). Survival outcomes were stratified by combination of pT and P in both periods, where OS was improved in the late period. Long-term survivors often underwent long-term postoperative chemotherapy with S-1.
  
  
  CONCLUSIONS
  Long-term postoperative S-1 chemotherapy may improve survival outcome of patients with type IV gastric cancer, and their prognosis is predicted by pT and P status.
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan keishi23@med.kitasato-u.ac.jp.
authors: Keishi
authors: K
authors: Yamashita
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Kei
authors: K
authors: Hosoda
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Natsuya
authors: N
authors: Katada
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Hiromitsu
authors: H
authors: Moriya
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Hiroaki
authors: H
authors: Mieno
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Katsuhiko
authors: K
authors: Higuchi
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Tohru
authors: T
authors: Sasaki
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Chikatoshi
authors: C
authors: Katada
authors: Department of Upper Gastrointestinal Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors: Shinichi
authors: S
authors: Sakuramoto
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Satoshi
authors: S
authors: Tanabe
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Wasaburo
authors: W
authors: Koizumi
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Shiro
authors: S
authors: Kikuchi
authors: Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors: Masahiko
authors: M
authors: Watanabe
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D009362:Neoplasm Metastasis; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
keywords: Type IV gastric cancer; chemotherapy; survival