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Linitis Plastica: a Distinct Type of Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Acknowledgments

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

Funding

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

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA

    Naruhiko Ikoma, Annamaria Agnes, Paul Mansfield & Brian D. Badgwell

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Hsiang-Chun Chen & Xuemei Wang

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela M. Blum & Jaffer A. Ajani

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das & Bruce Minsky

  5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella

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  1. Naruhiko Ikoma
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  2. Annamaria Agnes
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  3. Hsiang-Chun Chen
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Correspondence to Brian D. Badgwell.

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Ikoma, N., Agnes, A., Chen, HC. et al. Linitis Plastica: a Distinct Type of Gastric Cancer. J Gastrointest Surg 24, 1018–1025 (2020). https://doi.org/10.1007/s11605-019-04422-7

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  • DOI: https://doi.org/10.1007/s11605-019-04422-7

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