Gastric Linitis Plastica: recent trends, survival analysis and the role of adjuvant therapy

Aims Linitis plastica (LP) is an exceedingly rare type of gastric cancer with unclear incidence. It is characterized by diffuse tumor infiltration with thickening and stiffness of the gastric wall. Surgery is the gold standard management but the available data about the best surgical approach and adjuvant therapies are limited to very few studies and case reports. So this study aimed to conduct a comprehensive trend analysis for this rare disease and evaluate different surgical approaches for gastric LP management to provide an updated evidence to the literature [1] [2] [3].

Methods We obtained the data from the Surveillance, Epidemiology and End Results (SEER) database for patients diagnosed with gastric LP from 2000 to 2021. Trend analysis was performed using SEER*stat software version 8.4.3 to calculate the Percent Change (PC) and Annual Percent Change (APC). Patients were subdivided according to the treatment modality into two major groups: surgical management (partial and total gastrectomy) and medical therapy. The patients were further stratified according to the adjuvant therapy they received after the surgery into three groups: adjuvant chemotherapy, adjuvant radiotherapy and adjuvant combined chemoradiotherapy. We used SPSS 27 for data analysis, Kaplan-Meier curve and Log-Rank test for survival analysis.

Results Out of 981 patients with gastric LP, 55% were females and 45% males (RR=1.00, P<0.05). Males had a PC of -93.9 (APC=-11.0, P<0.05) and females had a PC of -92.6 (APC=-11.8, P<0.05). The majority were Caucasians (76.5%) with a PC of -92.0 (APC=-11.2, P<0.05) while African Americans represented 8% with a PC of -96.7 (APC=-13.1, P<0.05). Gastric LP had a 5-year relative survival outcome of 7.2%. Out of 158 patients treated surgically, 30.4% had partial gastrectomy while 69.6% had total gastrectomy with a 5-year relative survival of 18.7% and 10.3%; P=0.29. In partial gastrectomy: Adjuvant chemotherapy had no significant survival benefit compared to adjuvant radiotherapy and adjuvant chemoradiotherapy (29.1%, 34.9% and 22.4%; P=0.31) while in total gastrectomy; adjuvant chemotherapy had a 5-year survival of 8.9% compared to adjuvant radiotherapy (13.4%) and adjuvant chemoradiotherapy (11.2%); P=0.11.

Conclusions Gastric LP had a very poor survival outcome with significantly decreasing trends over the past two decades in both genders and races. However, it is more prevalent in Caucasians despite its scarcity. Due to the late presentation of the disease, total gastrectomy is widely preferred. However, partial gastrectomy had improved relative survival outcome compared to total gastrectomy although it had no statistical impact. In addition, adjuvant therapeutic modalities had no significant impact on the survival outcome after each surgical approach. These results highlight partial gastrectomy without systemic therapy as the modality of choice to avoid the severe complications associated with both total gastrectomy and adjuvant therapy to improve patients’ quality of life.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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• 2 Chen X., Zhi Y., Lin Z., Ma J., Mou W., Yu J.. Prognosis prediction model for a special entity of gastric cancer, linitis plastica. Journal of Gastrointestinal Oncology 2021; 12 (2): 307-327
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