To compare the clinicopathological and diagnositic features of Borrmann typeⅣ gastric cancer (GC) with other advanced GC and explore prognostic factors of the patients with Borrmann type Ⅳ GC.

A retrospective cohort analysis was performed in 612 patients undergoing surgery for advanced GC who were admitted to Beijing Friendship Hospital Capital Medical University from January 2013 to January 2021. The clinical diagnosis and pathological features of 80 patients (13.1%) with Borrmann typeⅣ and 532 patients (86.9%) with other Borrmann types of GC were compared. Kaplan-Meier method was used to describe the survival curve, and Cox proportional hazard model was used to analyze the univariate and multivariate survival.

There were statistically significant differences in age, family history of gastrointestinal tumor, surgical method, R0 resection, maximum tumor diameter, tumor area, tumor site, histopathological type, degree of differentiation, depth of invasion, lymph node metastasis and TNM stage among GC patients with Borrmann type Ⅳ compared with other Borrmann types (all P<0.05). The diagnostic accuracy rates of enhanced CT scan and visual gastroscopy of Borrmann type Ⅳ GC were 80.0% and 81.2% respectively, lower than 91.4% and 91.8% of other Borrmann types (all P<0.05). The positive rates of first gastroscopic biopsy of Borrmann type Ⅳ GC were 72.5%, which was significantly lower than 93.7% of other Borrmann types (P<0.05). There was no significant difference in the diagnostic level of upper gastrointestinal tract angiography between the two groups (96.2% vs 91.9%, χ²=0.593, P=0.701). Univariate and multivariate analysis showed that surgical method, tumor distribution, vascular invasion and whether to regulate chemotherapy were independent prognostic factors for GC patients with Borrmann typeⅣ (all P<0.05).

Borrmann type Ⅳ GC has unique clinicopathological characteristics, which requires multiple examination methods for identification. Surgical method, tumor distribution, vascular invasion and whether to regulate chemotherapy are important prognostic factors for Borrmann type Ⅳ GC.