Blackham Aaron U, Swords Doug S, Levine Edward A, Fino Nora F, Squires Malcolm H, Poultsides George, Fields Ryan C, Bloomston Mark, Weber Sharon M, Pawlik Timothy M, Jin Linda X, Spolverato Gaya, Schmidt Carl, Worhunsky David, Cho Clifford S, Maithel Shishir K, Votanopoulos Konstantinos I
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Ann Surg Oncol. 2016 Apr;23(4):1203-11. doi: 10.1245/s10434-015-4947-8. Epub 2015 Nov 3.
Current staging and treatment guidelines for gastric adenocarcinoma do not differentiate between linitis plastic (LP) and non-LP cancers. Significant controversy exists regarding the surgical management of LP patients.
Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 gastric cancer patients who underwent resection between 2000 and 2012 were identified. Clinicopathologic and outcomes data of 58 LP patients were compared to 811 non-LP patients.
Stage III/IV disease was more common at presentation in LP patients compared with non-LP patients (90 vs. 44 %, p < 0.01). Despite the fact that most LP patients underwent total gastrectomy (88 vs. 39 %, p < 0.01), final positive margins were more common in LP patients (33 vs. 7 %, p < 0.01). The use of frozen section allowed 15 intraoperative positive margins in 38 patients to be converted to negative final margins. Median overall survival (OS) was significantly worse in patients with LP (11.6 vs. 37.8 months, p < 0.01). There was no difference in median OS of LP patients based on stage (I/II, 17.3 mo; III, 10.6 mo; IV, 12.0 mo; p = 0.46). LP and non-LP patients who underwent optimal resection (negative margin and D2/3 lymphadenectomy) had better survival compared with those with nonoptimal resections. The median OS for optimally resected stage III LP (n = 22) and stage III non-LP (n = 185) patients was nearly identical (26.7 vs. 25.3 mo; p = 0.69).
Future staging systems and treatment guidelines should differentiate between LP and non-LP gastric cancers. Long-term survival in select LP patients who undergo optimal resections is comparable to optimally resected non-LP patients.
目前胃腺癌的分期及治疗指南并未区分皮革胃（LP）和非皮革胃癌。关于LP患者的手术治疗存在重大争议。
利用多机构参与的美国胃癌协作数据库，确定了2000年至2012年间接受手术切除的869例胃癌患者。将58例LP患者的临床病理及预后数据与811例非LP患者进行比较。
与非LP患者相比，LP患者就诊时III/IV期疾病更为常见（90%对44%，p<0.01）。尽管大多数LP患者接受了全胃切除术（88%对39%，p<0.01），但LP患者最终切缘阳性更为常见（33%对7%，p<0.01）。术中使用冰冻切片使38例患者中的15例术中切缘阳性转为最终切缘阴性。LP患者的中位总生存期（OS）明显更差（11.6个月对37.8个月，p<0.01）。基于分期，LP患者的中位OS无差异（I/II期，17.3个月；III期，10.6个月；IV期，12.0个月；p=0.46）。与未进行最佳切除的患者相比，接受最佳切除（切缘阴性及D2/3淋巴结清扫）的LP和非LP患者生存期更长。最佳切除的III期LP患者（n=22）和III期非LP患者（n=185）的中位OS几乎相同（26.7个月对25.3个月；p=0.69）。
未来的分期系统和治疗指南应区分LP和非LP胃癌。部分接受最佳切除的LP患者的长期生存率与接受最佳切除的非LP患者相当。
