Neoadjuvant intra-arterial chemoembolization improves tumor pathological regression and survival in Borrmann type IV gastric cancer

doi:10.5306/wjco.123351

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Aug 24, 2026; 17(8): 123351
Published online Aug 24, 2026. doi: 10.5306/wjco.123351

Neoadjuvant intra-arterial chemoembolization improves tumor pathological regression and survival in Borrmann type IV gastric cancer

Xiao-Xing Wu, Hou-Dun Yang, Jiang Min, Chao Yuan, Lian-Shuo Li, Wei Zhang, Yue Tong

Xiao-Xing Wu, Hou-Dun Yang, Jiang Min, Chao Yuan, Lian-Shuo Li, Wei Zhang, Yue Tong, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Co-first authors: Xiao-Xing Wu and Hou-Dun Yang.

Co-corresponding authors: Wei Zhang and Yue Tong.

Author contributions: Wu XX, Yang HD, Min J, Yuan C, Li LS, Zhang W, and Tong Y contributed to the data collection, analysis, and drafting or revision of the manuscript; Wu XX and Yang HD contributed equally to this manuscript as co-first authors; Zhang W and Tong Y contributed equally to this manuscript as co-corresponding authors. All authors have read and approved the final version of the manuscript.

AI contribution statement: During the preparation of this work, the author(s) did not use any generative AI or AI-assisted tools for literature search, data analysis, figure generation, or writing. All content was solely created by the author(s).

Supported by Chongqing Municipal Science and Technology Bureau, No. CSTB2025NSCQ-GPX1134.

Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (approval No. 2025-560-01).

Informed consent statement: Written informed consent for treatment was obtained from all patients. The institutional review board waived the requirement for additional informed consent for this retrospective analysis of anonymized data.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Yue Tong, Academic Fellow, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. natual101@gmail.com

Received: May 18, 2026
Revised: July 27, 2026
Accepted: August 20, 2026
Published online: August 24, 2026
Processing time: 101 Days and 6.7 Hours

Abstract

BACKGROUND

Gastric cancer (GC) is a significant global health challenge with high mortality rates. Borrmann type IV GC presents unique challenges owing to its aggressive biological characteristics and lack of specific clinical symptoms in the early stage, thus leading to advanced-stage diagnosis and poor prognosis.

AIM

To explore intra-arterial chemoembolization (IAC) as a novel treatment strategy for Borrmann type IV GC.

METHODS

We retrospectively analyzed 70 patients who underwent IAC followed by gastrectomy. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary outcomes included chemotherapeutic response, toxicities, pathological regression, postoperative morbidity, and mortality. Cox regression analysis was performed to identify independent prognostic factors for Borrmann type IV GC.

RESULTS

Seventy patients received neoadjuvant IAC followed by gastrectomy with a favorable safety profile (grade ≥ 3 adverse events: 8.6%). The objective response rate was 40.0%, with 20.0% of patients achieving pathological complete response (ypT0) and 52.9% achieving lymph node clearance (ypN0). The median OS and DFS were 21.0 months and 19.0 months, respectively, with 3-year OS and DFS rates of 40.3% and 40.0%, respectively. Regional lymph node regression (N-stage regression) was a significant independent protective factor for both OS and DFS regardless of the primary tumor response. Furthermore, objective pathological regression (complete/partial response) showed a potential association with improved survival.

CONCLUSION

Neoadjuvant IAC followed by D2 gastrectomy is a safe and highly effective strategy for the treatment of Borrmann type IV GC.

Keywords: Borrmann type IV; Gastric cancer; Intra-arterial chemoembolization; Gastrectomy; Lymph node

Core Tip: Borrmann type IV gastric cancer has a poor prognosis because of its diffuse and infiltrative growth pattern. In this retrospective of 70 patients, neoadjuvant intra-arterial chemoembolization followed by gastrectomy achieved an objective response rate of 40.0% with manageable toxicity. Primary-tumor pathological response was associated with better survival in unadjusted analyses, whereas N-stage regression remained independently associated with improved overall survival and disease-free survival after multivariable adjustment. Postoperative complications were associated with worse outcomes. These findings support N-stage regression as a clinically relevant prognostic marker and warrant prospective evaluation of intra-arterial chemoembolization as a therapeutic strategy for Borrmann type IV gastric cancer.