ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Borrmann Type 1 Cancer is Associated with a High Recurrence
Rate in Locally Advanced Gastric Cancer
Ji Hyun Kim, MD, Ph.D., Han Hong Lee, MD, Ph.D., Ho Seok Seo, MD, Yoon Ju Jung, MD, and Cho Hyun Park,
Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic
University of Korea, Seoul, Republic of Korea
Background. This study aimed to investigate the clini-
copathologic characteristics and outcomes of Borrmann
type 1 gastric cancer and evaluate its clinical signiﬁcance
in advanced gastric cancer compared with Borrmann types
2 and 3 cancer.
Methods. Between January 1989 and December 2013,
1949 patients with advanced gastric cancer who underwent
curative gastrectomy at our institution were enrolled in the
Results. Of the 1949 patients, 59 (3%) exhibited Bor-
rmann type 1 cancer, characterized by a large size, rare
serosal invasion, lower lymph node involvement, location
in the upper third of the stomach, intestinal type, and dif-
ferentiated histology. The recurrence rate was higher for
Borrmann type 1 than for Borrmann types 2 and 3 cancer.
In addition, more than half of the Borrmann type 1 recur-
rences showed a hematogenous pattern. However, overall
survival did not differ signiﬁcantly among the three cancer
types. In the multivariate analysis, Borrmann type 1 cancer,
with tumor depth, node metastasis, and vascular invasion,
was an independent risk factor associated with recurrence.
Particularly, Borrmann type 1 cancer showed a worse
prognosis in both overall survival and recurrence-free
survival than the other Borrmann types in the upper third of
Conclusions. Borrmann type 1 gastric cancer is associated
with a higher recurrence rate than Borrmann types 2 and 3,
but not with a difference in the overall survival rate.
Gastric cancer is a common malignant disease and
remains the third most frequent cause of cancer-related
The prognosis of patients with
advanced gastric cancer after radical surgery is mostly
related to disease extension such as depth of tumor and the
status of metastatic lymph nodes.
However, the risk of
recurrence in an individual can differ signiﬁcantly within
the same stage, and overall survival (OS) depends on
additional prognostic factors.
Recently, several studies
have reported that the primary tumor’s macroscopic fea-
tures, which could easily be obtained by preoperative
evaluations such as endoscopy, might be helpful in pre-
dicting the prognosis in patients with advanced gastric
Regarding the macroscopic classiﬁcation of advanced
gastric cancer, Borrmann classiﬁcation has been accepted
by many surgeons, endoscopists, radiologists, and pathol-
However, until currently, published
studies on the Borrmann classiﬁcation of stomach cancer
have focused primarily on Borrmann type 4 cancer, and
few have investigated other types of gastric cancer.
Borrmann type 1 gastric cancer has a unique morphologic
characteristic in that it grows toward the lumen instead of
invading the stomach wall. Moreover, because of its
characteristics, it would be expected to show a better
prognosis than other types.
However, little clinical
information is available on Borrmann type 1 cancer.
Electronic supplementary material The online version of this
article (https://doi.org/10.1245/s10434-018-6509-3) contains
supplementary material, which is available to authorized users.
Ó Society of Surgical Oncology 2018
First Received: 2 January 2018;
Published Online: 11 May 2018
H. H. Lee, MD, Ph.D.
Ann Surg Oncol (2018) 25:2044–2052