title: Clinicopathologic characteristics and prognosis of Borrmann type IV gastric cancer: a meta-analysis.
abstract: BACKGROUND
  The clinicopathologic features and surgical treatment strategy of Borrmann type IV (B-4) gastric cancer remains controversial. This meta-analysis was conducted to evaluate the clinicopathologic features of patients with B-4 gastric cancer and to assess whether or not non-curative resection improved prognosis.
  
  
  METHODS
  PubMed and Embase were searched for relevant articles. Statistical analysis was performed using RevMan (version 5.2). The odds ratio (OR), risk ratio (RR), hazard ratio (HR) with 95% confidence interval (CI), and weighted average of median survival times were calculated as effect values.
  
  
  RESULTS
  Fifteen studies were included. Compared with Borrmann type "others" (B-O), B-4 had a higher incidence of poorly differentiated carcinoma (OR=4.92; 95% CI=3.10-7.83; P<0.01), lymph node metastases (OR=2.13; 95% CI=1.88-2.41; P<0.01), peritoneal metastases (OR=3.91; 95% CI=3.37-4.54; P<0.01), serosal invasion (OR=3.66; 95% CI=2.91-4.60; P<0.01), and lymphatic invasion (OR=1.39; 95% CI=1.02-1.91; P=0.04). B-4 patients with non-curative resection were associated with a worse survival rate (HR=2.83; 95% CI=2.35-3.40; P<0.01) than patients with curative resection; however, B-4 patients with non-curative resection had a better survival rate (1-year: RR=0.70, 95% CI=0.63-0.77; P<0.01; 2-year: RR=0.90, 95% CI=0.85-0.94; P<0.01) than patients with non-resection.
  
  
  CONCLUSIONS
  Our meta-analysis indicated that B-4 patients were associated with poor tumor differentiation, lymph node metastases, peritoneal metastases, serosal invasion, lymphatic invasion, and prognosis. Curative resection may increase the survival rate for B-4 patients. If it is not possible to perform a curative resection, a non-curative resection may improve the prognosis.
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. luoyifan881128@sina.com.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. gaokaji16@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. songyongxi840309@126.com.
authors.forename: Yongxi
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. sun2003999@163.com.
authors.forename: Jingxu
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. qq_347310502@126.com.
authors.forename: Xuanzhang
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. zjh900521@163.com.
authors.forename: Junhua
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. mabin0326cmu@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. 15942066533@163.com.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China. josieon826@sina.cn.
authors.forename: Zhenning
authors.initials: Z
authors.lastname: Wang
mesh_terms: D005743:Gastrectomy; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*