Aims Linitis plastica (LP) is an exceedingly rare type of gastric cancer with unclear
incidence. It is characterized by diffuse tumor infiltration with thickening and stiffness
of the gastric wall. Surgery is the gold standard management but the available data
about the best surgical approach and adjuvant therapies are limited to very few studies
and case reports. So this study aimed to conduct a comprehensive trend analysis for
this rare disease and evaluate different surgical approaches for gastric LP management
to provide an updated evidence to the literature [1]
[2]
[3].
Methods We obtained the data from the Surveillance, Epidemiology and End Results (SEER) database
for patients diagnosed with gastric LP from 2000 to 2021. Trend analysis was performed
using SEER*stat software version 8.4.3 to calculate the Percent Change (PC) and Annual
Percent Change (APC). Patients were subdivided according to the treatment modality
into two major groups: surgical management (partial and total gastrectomy) and medical
therapy. The patients were further stratified according to the adjuvant therapy they
received after the surgery into three groups: adjuvant chemotherapy, adjuvant radiotherapy
and adjuvant combined chemoradiotherapy. We used SPSS 27 for data analysis, Kaplan-Meier
curve and Log-Rank test for survival analysis.
Results Out of 981 patients with gastric LP, 55% were females and 45% males (RR=1.00, P<0.05).
Males had a PC of -93.9 (APC=-11.0, P<0.05) and females had a PC of -92.6 (APC=-11.8,
P<0.05). The majority were Caucasians (76.5%) with a PC of -92.0 (APC=-11.2, P<0.05)
while African Americans represented 8% with a PC of -96.7 (APC=-13.1, P<0.05). Gastric
LP had a 5-year relative survival outcome of 7.2%. Out of 158 patients treated surgically,
30.4% had partial gastrectomy while 69.6% had total gastrectomy with a 5-year relative
survival of 18.7% and 10.3%; P=0.29. In partial gastrectomy: Adjuvant chemotherapy
had no significant survival benefit compared to adjuvant radiotherapy and adjuvant
chemoradiotherapy (29.1%, 34.9% and 22.4%; P=0.31) while in total gastrectomy; adjuvant
chemotherapy had a 5-year survival of 8.9% compared to adjuvant radiotherapy (13.4%)
and adjuvant chemoradiotherapy (11.2%); P=0.11.
Conclusions Gastric LP had a very poor survival outcome with significantly decreasing trends
over the past two decades in both genders and races. However, it is more prevalent
in Caucasians despite its scarcity. Due to the late presentation of the disease, total
gastrectomy is widely preferred. However, partial gastrectomy had improved relative
survival outcome compared to total gastrectomy although it had no statistical impact.
In addition, adjuvant therapeutic modalities had no significant impact on the survival
outcome after each surgical approach. These results highlight partial gastrectomy
without systemic therapy as the modality of choice to avoid the severe complications
associated with both total gastrectomy and adjuvant therapy to improve patients’ quality
of life.
