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.