Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Gastrointest Surg. 2020 May;24(5):1018-1025. doi: 10.1007/s11605-019-04422-7. Epub 2019 Nov 21.
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.
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.
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.
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.
局限性胃癌（LP）患者的预后较差。本回顾性研究的目的是使用明确的定义来描述 LP 患者的临床病理特征和生存结果。
我们将 LP 定义为胃壁 1/3 以上受累的胃癌。我们对接受胃切除术的 LP 患者和非 LP 患者的临床病理因素进行了回顾性分析，并对其进行了总结和比较。使用倾向评分匹配对患者进行 1:1 匹配，比较其总生存（OS）率和持续时间。使用胃切除术作为时变协变量进行多变量 Cox 回归分析。
我们共纳入 740 例影像学无转移的胃癌患者，其中 157 例（21.2%）患者为 LP。大多数 LP 患者处于晚期疾病（75.8%为 IV 期疾病，主要由于腹膜受累）。与非 LP 患者相比，LP 患者在全队列（中位 OS，14.0 与 33.5 个月；p 值<0.001）和手术队列（胃切除术后中位 OS，21.8 与 91.0 个月；p<0.001）中，以及在倾向评分匹配的手术队列中，OS 持续时间更短。在 LP 队列中，化疗（风险比 [HR] = 0.594；p = 0.076）、放化疗（HR = 0.346；p = 0.001）和胃切除术（HR = 0.425；p = 0.003）与 OS 延长相关。
LP 是一种胃癌表型，常表现为晚期，腹膜受累率高。在本研究中，即使在手术队列中，LP 患者的生存时间也较差。在仔细选择的局限性 LP 患者中，术前化疗、放化疗和胃切除术的应用似乎很重要。
