Christodoulidis Grigorios, Agko Sara Eirini, Koumarelas Konstantinos Eleftherios, Kouliou Marina Nektaria
Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece.
Intensive Care Unit, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden 65197, Germany.
World J Exp Med. 2025 Mar 20;15(1):96318. doi: 10.5493/wjem.v15.i1.96318.
Gastric cancer ranks fifth as the most common cancer and third as the leading cause of death worldwide. Risk factors include advancing age, low-fiber diets, high salt intake and infection. Diagnosis relies on histological examination following endoscopic biopsy with staging accomplished through various imaging modalities. Early gastric cancer is primarily managed endoscopic resection, while non-early operable cases typically undergo surgery. Advanced cases are addressed through sequential chemotherapy lines, with initial treatment usually comprising a platinum and fluoropyrimidine combination. Linitis plastica (LP) is a rare, aggressive form of gastric cancer characterized by diffuse infiltration of the gastric wall, resulting in poor outcomes even after curative resection. The absence of a standardized definition contributes to uncertainty regarding the precise incidence of these tumors. LP is often diagnosed at advanced stages, with a reported median survival rate of approximately 4%-29%, despite "curative resection". Its distinctive biological behavior includes perineural invasion, nodal metastasis, and peritoneal dissemination. The bleak prognosis for LP patients partly stems from delayed diagnosis and its aggressive biological nature, posing significant challenges for clinical management. Currently, no specialized treatment strategy exists for LP, and clinical approaches typically align with those used for general gastric cancer treatment. Surgical resection is the primary treatment, but the optimal surgical approach remains contentious. Recent studies have investigated the efficacy of neoadjuvant chemotherapy and radiotherapy in improving survival outcomes for LP patients. However, controversies persist regarding the role of adjuvant chemotherapy and postoperative radiotherapy. LP requires a multidisciplinary approach and personalized treatment strategies tailored to each patient's condition. Further research is needed to elucidate optimal therapeutic interventions and improve outcomes for LP patients.
胃癌是全球第五大常见癌症，也是第三大主要死因。风险因素包括年龄增长、低纤维饮食、高盐摄入和感染。诊断依赖于内镜活检后的组织学检查，并通过各种成像方式进行分期。早期胃癌主要通过内镜切除治疗，而非早期可手术病例通常接受手术。晚期病例通过序贯化疗方案进行治疗，初始治疗通常包括铂类和氟嘧啶联合使用。皮革胃（LP）是一种罕见的侵袭性胃癌，其特征是胃壁弥漫性浸润，即使进行根治性切除后预后也较差。缺乏标准化定义导致这些肿瘤的确切发病率存在不确定性。LP通常在晚期被诊断出来，尽管进行了“根治性切除”，但其报告的中位生存率约为4%-29%。其独特的生物学行为包括神经周围侵犯、淋巴结转移和腹膜播散。LP患者预后不佳部分源于诊断延迟及其侵袭性生物学特性，给临床管理带来了重大挑战。目前，尚无针对LP的专门治疗策略，临床方法通常与一般胃癌治疗方法一致。手术切除是主要治疗方法，但最佳手术方式仍存在争议。最近的研究调查了新辅助化疗和放疗对改善LP患者生存结局的疗效。然而，关于辅助化疗和术后放疗的作用仍存在争议。LP需要多学科方法和根据每个患者情况量身定制的个性化治疗策略。需要进一步研究以阐明最佳治疗干预措施并改善LP患者的结局。
