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Linitis Plastica: a Distinct Type of Gastric Cancer

  • Naruhiko Ikoma
  • Annamaria Agnes
  • Hsiang-Chun Chen
  • Xuemei Wang
  • Mariela M. Blum
  • Prajnan Das
  • Bruce Minsky
  • Jeannelyn S. Estrella
  • Paul Mansfield
  • Jaffer A. Ajani
  • Brian D. BadgwellEmail author
Original Article

Abstract

Background

The prognosis of patients with linitis plastica (LP) gastric cancer is reported to be poor. The purpose of our retrospective study was to characterize the clinicopathologic features and survival outcomes of patients with LP, using a univocal definition.

Methods

We defined LP as gastric cancer that involves more than 1/3 of the gastric wall macroscopically. We reviewed a prospectively maintained institutional database of gastric cancer patients and summarized and compared clinicopathologic factors of patients with and without LP who had undergone gastrectomy. Patients were matched 1:1 using propensity score matching, and their overall survival (OS) rates and durations were compared. Multivariable Cox regression analyses were conducted, using gastrectomy as a time-varying covariate.

Results

We identified 740 patients with radiographically non-metastatic gastric cancer, 157 (21.2%) of whom had LP. Most patients with LP had advanced-stage disease (75.8% had stage IV disease, mainly due to peritoneal involvement). Patients with LP had significantly shorter OS durations than did those without LP in the entire cohort (median OS, 14.0 vs. 33.5 months; p value < 0.001) and in the surgical cohort (median OS after gastrectomy, 21.8 vs. 91.0 months; p < 0.001), as well as in the propensity-matched surgical cohort. In the LP cohort, chemotherapy (hazard ratio [HR] = 0.594; p = 0.076), chemoradiation therapy (HR = 0.346; p = 0.001), and gastrectomy (HR = 0.425; p = 0.003) were associated with a longer OS.

Conclusions

LP is a phenotype of gastric cancer that often presents at an advanced stage, with a high rate of peritoneal involvement. The survival durations of patients with LP were poor in our study, even in the surgical cohort. The use of preoperative chemotherapy, chemoradiation therapy, and gastrectomy appeared to be important in carefully selected patients with localized LP.

Keywords

Linitis plastica Gastric cancer Diffuse Signet ring Gastrectomy Borrmann type IV Scirrhous carcinoma 

Notes

Acknowledgments

We thank the Department of Scientific Publications at MD Anderson for editorial assistance.

Funding Information

This study was supported in part by the National Institutes of Health under award number P30 CA016672 and by the Clinical Trials Support Resource.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Naruhiko Ikoma
    • 1
  • Annamaria Agnes
    • 1
  • Hsiang-Chun Chen
    • 2
  • Xuemei Wang
    • 2
  • Mariela M. Blum
    • 3
  • Prajnan Das
    • 4
  • Bruce Minsky
    • 4
  • Jeannelyn S. Estrella
    • 5
  • Paul Mansfield
    • 1
  • Jaffer A. Ajani
    • 3
  • Brian D. Badgwell
    • 1
    Email author
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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