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Adil Ayub, MD: Disclosure information not submitted.
Introduction: Gastric linitis plastica (LP) is exceedingly rare. We sought to investigate the clinical outcomes utilizing a national database.
Methods: The National Cancer Database (NCDB) 2004 - 2017 was queried for patients with gastric LP. Baseline patient and tumor characteristics, and treatment outcomes including receipt of surgical resection, chemotherapy and radiation therapy were evaluated.
Results: There were 896 patients with gastric LP (mean age 63.1 ±14.4 years). Patients were predominantly white (78.5%), presented at advanced stage III/IV disease (45%) and had higher grade III/IV disease (70.2%). 369 (41.2%) patients underwent surgical resection including total gastrectomy = 189 (51.2%) and partial/subtotal gastrectomy = 139 (37.7%, 520 (58.0%) received chemotherapy and 158 (17.6%) received radiation therapy. Mean OS (overall survival) of the entire cohort was 16.9 months with 1-year and 5-year OS rates of 33% and 5%, respectively. Mean OS for the patients receiving surgery with chemotherapy and/or radiation, surgery alone, chemotherapy and/or radiotherapy alone, and no treatment was 28.4, 17.1, 12.3 and, 8.1 months, respectively (Figure 1a, P< 0.001). On Cox-regression analysis, advanced-stage disease (stage IV) (P< 0.001), no surgical resection (P< 0.001) and no chemotherapy (P< 0.001) were associated with an increased hazard of death. Among surgical patients, R0 resection was achieved in 170 (46.1%) cases, 162 (43.9%) had ≥16 lymph nodes examined. Patients who underwent total gastrectomy had a higher 90-day mortality rate (16.7% vs. 13.2%) and lower mean OS (20.1 vs. 32.9 months, P = 0.009, Figure 1b) compared to patients who received partial/subtotal gastrectomy. Over time, the proportion of patients receiving surgical resection (30.7% from 48.3%) and radiation therapy decreased (13.8% from 20.6%) and the use of chemotherapy increased (63.9% from 54.8%).
Conclusions: Multimodal therapy including surgical resection and systemic therapy is associated with improved survival in patients with gastric LP. Partial/subtotal gastrectomy with RO resection and chemotherapy appears to provide the best early and long-term outcomes in select group of patients.
Learning Objectives:
Define linitis plastica
Describe the baseline characteristics in a large cancer database
Demonstrate the outcomes of different treatment regiments for gastric linitis plastics