J.Jpn. Surg. Soc.. 61(2): 224-233, 1960

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ON THE HISTOLOGICAL MALIGNANCY (BRODERS) IN ECTOMIZED STOMACH CANCER

The grades of malignancy in 833 cases of stomach cancers extracted by ordinary gastrectomy was recorded according to the method of Broders as BR. I., II., III. and IV. and these were studied in correlation with the pathohistological findings of the carcinomatous tissues and the late results of the operation.
The results obtained are as follows :
1) The 833 specimens studied comprised 105 cases of BR. I. (12.6%), 179 of BR. II. (21.3%), 281 of BR. III. (33.7%) and 268 of BR. IV. (32.2%), the cases of BR. III. and IV. of high histological malignancy accounting for the majority or 65.9 percent of the total.
2) High malignancy of BR. III. or IV. was confirmed in 292 or 69.5 percent of the cases of large tumors above 40 cm2 in area, in 299 or 64 .9 percent of medium sized tumors (20-39 cm²), in 158 or 67.0 percent of small tumors (10- 19 cm²) and in 84 or 54.6 percent of very small tumors of less than 9 cm², therefore, no correlation could be established between the BR. malignancy and the size of tumors.
3) The frequency of BR. III.-IV. cases among the Borrmann's macroscopic cancer types I. and II. was 44.0- 58.2 percent and among his types III. and IV. cases 80.5- 83.4 percent. Here, the cases of high malignancy was far more frequent among the Borrmann's types III. and IV.
4) By histological types, Ca. adenomatosa cases comprised the majority or 60.9 percent of BR. I.-II. cases with low malignancy, but the majority of the Ca. solidum and the mixed type cancer cases were found in BR. III. and IV. cases (88.0- 89.7%) , so that a statistically significant difference was found between these two groups with regard to malignancy.
5) The frequency of BR. III. and IV. cases was 31.6 percent in the Sm type cases with the carcinomatous cells localized only in the submucosa, 49.5 percent in the M type cases with carcinomatous infiltration reaching the tunica muscularis and 74.0 percent in S type cases with the infiltration reaching the tela subserosa, revealing the higher frequency of bad malignancy, the deeper the carcinomatous infiltration in the gastric wall.
6) The frequency of cases with metastasis of stomach cancers to the regional lymph nodes was 72.3 percent among BR. I. cases, 63.8 percent in BR. II. cases, 87.2 percent for BR. III. cases and 88.1 percent with BR. IV. cases, showing a slightly higher frequency for the high malignancy cases.
7) In our clinic, four grades of carcinomatous peritonitis have been established according to the severity of macroscopic findings at surgical operation as corrected by the results of microscopic examinations. Among my 833 specimens, a) 188 cases were of PC. (peritonitis carcinomatosa) O grade, showing no trace of carcinomatous dissemination either macroscopically or histologically to the peritoneum or the omentum, b) 448 were PC. I. cases with the dissemination limited to the parts of the peritoneum and the omentum near the gastric tumor and 197 PC. II. cases with more wide-spread carcinomatous dissemination reaching the serosa of the adjacent organs. The frequency of BR. III. and IV. grade cases was 53.0 percent among the PC. 0 cases, 63.9 percent in the PC. I. cases and 83. 7 percent for the PC. II. cases. Thus, high malignacy was the more frequent, the more advanced the carcinomatous dissemination.
8) The rates of survival for one year after the operation were 90.5 percent in BR. I. cases, 82.7 percent in BR. II. cases, 75.1 percent in BR. III. cases and 55.3 percent in BR. IV. cases. The three years' survival rates were 66.7 percent (BR. I.) , 50.1 percent (BR. II. ) , 35.8 percent (BR. III.) and 17.0 percent (BR.IV.) , respectively, and the five years' survival rates were 62.3 percent, 28.3 percent and 9.6 percent respectively in the same order. Of course the survival rate was found to be higher, the lower the malignancy grade, and the difference between the rates was always statistically significant.
On the other hand, according to our PC. classification, the rates of one year's survival were 98.4 percent among the PC. O cases, 76.3 percent in the PC. I. cases and 39.1 percent among the PC. II. cases, the three years' survival rates 87.4 percent, 1.8 percent and the five years survival rates 78.6 percent, 24.8 percent and O in the same order of ascending PC. grades, respectively. The difference between the rates among the O, I., II. grade cases here was very marked-more marked than that between the BR. grades.
(Author's abstract)

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