Gastric linitis plastica: Have we moved beyond surgical palliation?

Abstract

184 Background: Diffuse type gastric cancer (DGC), especially linitis plastica (LP), is associated with poor survival. Despite curative-intent surgical resection and improvement in perioperative therapy, doubt remains whether long term survival is possible in this aggressive disease. Methods: A retrospective review of the GC database at a comprehensive cancer center was reviewed from 2000 to 2016. Patient demographics, tumor characteristics, and treatment were evaluated. Patients with DGC were assessed. LP was defined as patients with DGC who had circumferential infiltration of the gastric wall for at least a third of the stomach length. Descriptive statistics were used to compare DGC and LP groups; survival was assessed by the Kaplan-Meier method. Results: Of 209 resected GC patients, 114 had diffuse histology; the majority were of the signet ring cell subtype. 38 (33.3%) had LP and 76 (66.7%) had DGC without linitis. LP patients were more likely to present at a later stage, with 27/38 patients (71%) with stage III and 4/38 patients (10.5%) with stage IV compared to 16/76 (21.1%) and 2/76 (2.6%) in the DGC group, respectively, p < 0.001. All patients underwent gastric resection with some for palliative intent including 6 patients found to have metastatic disease on exploration. R0 resection was achieved in 26 patients (68.4%) with LP. Median OS was 31.5 months for the cohort and 13.6 months for LP patients (p < 0.001); survival in LP patients did not improve with R0 resection. When survival was stratified by stage, patients with stage II LP still had a lower median OS than DGC (18.4 vs. 51.2 months, respectively, p = 0.015), though there was no survival differences in stage III and IV. Only half of patients with LP received preoperative chemotherapy or chemoradiation, perhaps due to need for surgical palliation of symptoms; receipt of preoperative therapy was not associated with survival in this subgroup. Conclusions: Gastric LP is associated with a poor prognosis. Early diagnosis and adherence to multimodal therapy may improve survival after surgical resection. Development of novel agents and improvement in neoadjuvant therapy is needed to improve outcomes in this aggressive disease.