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THE EFFECT OF DIFFERENT TREATMENT MODALITIES ON THE SURVIVAL OF PATIENTS WITH LINITIS PLASTICA
Omidreza Tabatabaie*, Gyulnara G. Kasumova, Meir Mizrahi, Tyler M. Berzin, Ayotunde B. Fadayomi, Promise O. Ukandu, Sing Chau Ng, Mark P. Callery, Mandeep Sawhney, Jennifer F. Tseng
Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Background: Linitis plastica (LP) is an uncommon but aggressive form of gastric adenocarcinoma that usually presents at advanced stages and has a dismal prognosis. The aim of this study was to analyze the effects of different treatment modalities on LP.
Methods: National Cancer Database (NCDB) 2004-2014 was queried for patients with histologic diagnosis of gastric adenocarcinoma and divided into LP and non-LP gastric adenocarcinoma (GAC) based on defined variables. Patients with unknown stage and/or treatment modality were excluded. Treatment groups were defined as chemo and/or radiotherapy, surgery plus chemotherapy and/or radiotherapy, surgery alone and no treatment. Chi square and Kaplan-Meier methods were used to compare patient and tumor characteristics and to calculate median overall survivals, respectively.
Results: Of the 118,468 included patients with gastric cancer, 893 (0.8%) had LP. Median age was 66.0 [IQR=58.0-78.0] and 69.0 [IQR=55.0-76.0] for patients with LP and GAC, respectively. There was a female predominance in patients with LP as compared to those with GAC (52.9% vs 35.4%, p-value<0.0001). Compared to those with GAC, patients with LP were more likely to have high grade/undifferentiated tumors (91.1% vs 67.4%; p-value<0.0001) and metastatic disease (63.1% vs 49.1%; p-value<0.0001). Moreover, LP patients were less often treated at academic centers compared to those with GAC (30.1% vs 38.56% p-value<0.0001). The proportion of patients that received surgical resection or chemotherapy did not differ between LP and GAC (41% vs 43% for surgery and 52.6% vs 51.3% for chemotherapy in LP and GAC, respectively); however, fewer patients with LP received radiotherapy (17.5% vs 28.6% p-value<0.0001).
Overall median survival in patients with LP and GAC was 6.8 months (95%CI=6.4-7.4) and 12.4 months (95%CI=12.3-12.6), respectively (Figure 1). Median survivals by reported stage for patients with LP and GAC (in months) were 11.3 (95%CI=8.7-16.7) and 39.4(95%CI=37.9-41.2) for stage I, 12.2(95%CI=8.8-14.8) and 24.4(95%CI=23.4-25.2) for stage II, 8.2(95%CI=7.2-11.0) and 16.6 (95%CI=16.3-17.1) for stage III, and 4.8(95%CI=4.1-5.4) and 5.2(95%CI=5.3-5.6) for stage IV (all P<0.05). Median survivals for each treatment group and by stage are given in Table 1. Across both cohorts, resection plus chemotherapy/radiotherapy conferred the best survival results as compared to surgery only or non-surgical intervention. However, across all stages and treatment groups, patients with LP had inferior survival than those with non-LP GAC.
Conclusion: Prognosis for patients with LP remains poor. However, despite worse prognosis compared with non-LP patients, linitus plastica patients who are reasonable candidates should be offered resection and systemic treatment, which prolong survival.
Table 1. Median survival of patients with Linitis plastica (LP) and other gastric adenocarcinomas (GAC) by different treatment modalities.
| | Median survival (months) | LCL | UCL | | Stage1-2 GAC | | | | | None | 11.70 | 10.84 | 12.58 | | Chemotherapy/radiotherapy | 14.98 | 14.55 | 15.64 | | Surgery | 63.64 | 60.25 | 67.02 | | Surgery + chemotherapy/radiotherapy | 48.00 | 45.83 | 51.02 | | Stage1-2 LP | | | | | None | 4.50 | 2.33 | 4.93 | | Chemotherapy/radiotherapy | 10.41 | 7.95 | 14.88 | | Surgery* | N/A | N/A | N/A | | Surgery ±chemotherapy/radiotherapy | 22.08 | 13.67 | 26.94 | | Stage3-4 GAC | | | | | None | 1.64 | 1.61 | 1.71 | | Chemotherapy/radiotherapy | 8.61 | 8.48 | 8.67 | | Surgery | 5.39 | 5.06 | 5.72 | | Surgery + chemotherapy/radiotherapy | 22.21 | 21.59 | 22.90 | | Stage3-4 LP | | | | | None | 1.87 | 1.61 | 2.17 | | Chemotherapy/radiotherapy | 7.36 | 6.57 | 8.34 | | Surgery | 4.17 | 2.83 | 8.28 | | Surgery + chemotherapy/radiotherapy | 10.00 | 7.98 | 13.27 |
LP: Linitis plastica; GAC: gastric adenocarcinoma, LCL: lower 95% confidence limit; UCL: upper 95% confidence limit *Not reportable according to the National Cancer Database guidelines.  LP= Linitis plastica, GAC=non-linitis plastica gastric adenocarcinoma
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