The efficacy of treating patients with non-metastatic gastric linitis plastica using surgery with chemotherapy and/or radiotherapy

Abstract

Background: To explore the efficacy of treatment strategies for non-metastatic gastric linitis plastica (GLP). Methods: Patients with non-metastatic GLP from 2004 to 2014 were identified from the National Cancer Database (NCDB). We compared overall survival (OS) of those patients who received different treatments, including surgery alone, a combination of surgery with chemotherapy and/or radiotherapy (S + C/R), chemotherapy and/or radiotherapy (C/R), and no treatment. Results: The cohort included 474 patients with non-metastatic GLP. Overall, the median survival was significantly different among four groups (13.90 months in S + C/R, 8.38 months in surgery alone, 8.94 months in C/R and 2.50 months in no treatment). Then, we compared the efficacy of surgery alone and surgery with postoperative chemotherapy and/or radiotherapy (S + post C/R). When the tumor size was greater than 8 cm in stage III patients, S + post C/R was associated with a better survival benefit than surgery alone. S + post C/R also conferred an obvious survival advantage compared to surgery alone for R0 patients with positive lymph nodes and patients with positive margins. Conclusions: Surgery plays the fundamental role in improving the OS of patients with non-metastatic GLP. S + post C/R would benefit patients in stage III with large-sized tumors (>8 cm), patients with negative margins and positive lymph nodes, and/or patients with positive margins.

The Genomic Signatures of Linitis Plastica Signal the Entrance into a New Era: Novel Approaches for Diagnosis and Treatment

“…The standard treatment of LP typically involves gastrectomy with resection margins exceeding 5 cm to achieve R0 resection and D2 lymph node dissection following the guidelines of the Japanese Gastric Cancer Association. In cases where this is not feasible, palliative gastrectomy is performed [7,11,36,37]. Radiotherapy has limited effectiveness against diffuse cancers [7].…”

“…Current guidelines and practices recommend gastrectomy with resection margins of at least 5 cm for achieving R0 resection along with D2 lymph node dissection (Japanese Gastric Cancer Association, JGCA). In cases where such surgery is not feasible, palliative gastrectomy may be performed in an attempt to manage bleeding and pyloric obstruction [7,11,36,37]. The choice of gastrectomy type depends on the disease stage, size, layer infiltration and involvement of surrounding structures.…”

Revolutionizing gastric linitis plastica diagnosis: the crucial role of EUS-FNA in a sequential diagnostic approach

“…Despite undergoing ‘curative resection,’ a significant majority of these tumors are detected in advanced stages, leading to a median survival ranging from 5 to 17 months and a 5-year survival rate between 4% and 29% 3 – 5 . The unique biological characteristics associated with these tumors contribute to an elevated risk of perineural invasion, nodal metastases, peritoneal spread, and direct infiltration into surrounding tissues, likely accounting for the observed outcomes 6 , 7 .…”