Abstract
Gastric linitis plastica (GLP) is a descriptive term but lacks a quantitative definition. Several relatively quantitative criteria had been proposed, such as tumor involving a limit of one-third or two-thirds of the gastric surface. However, these criteria needed doctors to subjectively judge tumor infiltration area, which made diagnosis difficult to be objective and reproducible. This study aimed to propose a quantitative diagnostic criterion for distinguishing GLP. We performed a retrospective cohort study of 2,907 patients with Borrmann III and IV gastric cancer (GC) who underwent gastrectomy between 2011 and 2018 in our center. The Kaplan–Meier curves showed that patients with an observed tumor size more than 8 cm had obviously lower overall survival (OS) and disease-free survival (DFS) rates than those with a size less than 8 cm(p < 0.001; p < 0.001). However, there was no significantly different prognosis of patients with tumor sizes between more than 8 cm and more than 10 cm (p = 0.248; p = 0.534). Moreover, patients with tumor sizes greater than 8 cm more presented with advanced stage and had extremely poor 3-year OS and DFS (31.4%; 29.3%), with a stronger propensity toward peritoneal metastasis. Therefore, we considered patients’ observed tumor size more than 8 cm as a critical value for distinguishing the prognosis of Borrmann III and IV GC. Furthermore, we proposed an observed tumor size more than 8 cm as a quantitative diagnostic criterion for GLP on the premise of satisfying the originally descriptive and pathological definition regardless of Borrmann type.
Highlights
Gastric cancer (GC) is the fifth malignancy worldwide and the second most commonly diagnosed cancer in China [1, 2]
As the objective of this study was to propose a quantitative diagnosis for Gastric linitis plastica (GLP) by survival analysis, we only selected Borrmann III and Borrmann IV gastric adenocarcinoma as study population referring to JCOG0210 and JCOG0501
We were surprised to find that 11.9% (36/302) of patients’ pathological tumor sizes were less than 3 cm, and 25.8% (78/302) of patients’ sizes were between 3 and 5 cm among 302 Borrmann IV gastric cancer (GC) according to our pathological reports
Summary
Gastric cancer (GC) is the fifth malignancy worldwide and the second most commonly diagnosed cancer in China [1, 2]. Gastric linitis plastica (GLP) is a special phenotype of GC found in 7%–14% of cases and represents a particular entity [3] It is characterized macroscopically as a thickened stomach, with prominent diffusion of the tumor into the submucosal and muscular layers and Quantitative Definition of GLP microscopically by the association with signet ring cell features and diffuse and scirrhous histologic types [4, 5]. Curative resection is possible in less than half of patients, and early recurrence is common, leading to a poor prognosis, median survival ranging from 6 to 12 months, and 5-year survival between 8% and 13% [9,10,11,12,13] Despite these specific features, GLP still lacks a clear and standardized definition. There is a need for a simple and macroscopic criterion that could be used in clinical practice to aid surgeons and oncologists to arrive at a definite diagnosis preoperatively [16]
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