Is linitis plastica a contraindication for surgical resection? A 7-institution study of the U.S. Gastric Cancer Collaborative.

118 Background: Linitis plastica (LP) describes a diffusively infiltrative gastric adenocarcinoma that portends poor prognosis. Current treatment guidelines do not differentiate between LP and non-LP cancers and it is not known if the same staging system should be applied to both situations. Methods: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 patients with gastric adenocarcinoma who underwent resection between 2000-2012 were identified. Clinicopathologic, perioperative and survival outcomes of the 58 patients with LP were compared to the 811 patients without LP. Results: Advanced disease (stage III/IV) at presentation was more common in patients with LP compared to non-LP patients (90 vs 44%, p<0.01). Despite the fact that most LP patients underwent total gastrectomy (88% vs 57%, p<0.01), positive margins were more common in LP patients (33 vs 7%, p<0.01). There was no difference in perioperative complications (48 vs 43%, p=0.45) or mortality (7 vs 3%, p=0.12) between LP and non-LP patients. While survival correlated with stage in non-LP patients, there was no difference in median overall survival (OS) of LP patients based on stage (I/II, 17.3 mos; III, 10.6 mos; IV, 12.0 mos; p=0.46). Median OS was significantly worse in patients with LP (11.6 vs 37.8 months, p<0.01) when margin status and extent of lymphadenectomy were not factored in the analysis. However, when analyzing only patients with optimal resections (R0, D2 lymphadenectomy), the median OS for stage III LP (n=22) and non-LP (n=185) patients was nearly identical (26.8 vs 25.3 mos, p=0.69). There were no independent prognostic factors identified to predict survival in LP patients undergoing curative resection. Conclusions: The poor prognosis of LP gastric cancer is due primarily to its advanced stage at diagnosis. However, LP patients who undergo optimal resections can expect similar long term survival compared to optimally resected non-LP patients with advanced stage disease. Patient selection and multidisciplinary management are paramount when considering surgical resection in patients with gastric LP.

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Gastric linitis plastica: Have we moved beyond surgical palliation?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.184 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 184-184 ◽

Cited By ~ 1

Author(s):

Katherine Woo ◽

Carrie Luu ◽

Khaldoun Almhanna ◽

Domenico Coppola ◽

Jose Mario Pimiento ◽

...

Keyword(s):

Surgical Resection ◽

Gastric Wall ◽

Linitis Plastica ◽

Stage Iii ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

R0 Resection ◽

Term Survival ◽

Aggressive Disease ◽

Surgical Palliation

184 Background: Diffuse type gastric cancer (DGC), especially linitis plastica (LP), is associated with poor survival. Despite curative-intent surgical resection and improvement in perioperative therapy, doubt remains whether long term survival is possible in this aggressive disease. Methods: A retrospective review of the GC database at a comprehensive cancer center was reviewed from 2000 to 2016. Patient demographics, tumor characteristics, and treatment were evaluated. Patients with DGC were assessed. LP was defined as patients with DGC who had circumferential infiltration of the gastric wall for at least a third of the stomach length. Descriptive statistics were used to compare DGC and LP groups; survival was assessed by the Kaplan-Meier method. Results: Of 209 resected GC patients, 114 had diffuse histology; the majority were of the signet ring cell subtype. 38 (33.3%) had LP and 76 (66.7%) had DGC without linitis. LP patients were more likely to present at a later stage, with 27/38 patients (71%) with stage III and 4/38 patients (10.5%) with stage IV compared to 16/76 (21.1%) and 2/76 (2.6%) in the DGC group, respectively, p < 0.001. All patients underwent gastric resection with some for palliative intent including 6 patients found to have metastatic disease on exploration. R0 resection was achieved in 26 patients (68.4%) with LP. Median OS was 31.5 months for the cohort and 13.6 months for LP patients (p < 0.001); survival in LP patients did not improve with R0 resection. When survival was stratified by stage, patients with stage II LP still had a lower median OS than DGC (18.4 vs. 51.2 months, respectively, p = 0.015), though there was no survival differences in stage III and IV. Only half of patients with LP received preoperative chemotherapy or chemoradiation, perhaps due to need for surgical palliation of symptoms; receipt of preoperative therapy was not associated with survival in this subgroup. Conclusions: Gastric LP is associated with a poor prognosis. Early diagnosis and adherence to multimodal therapy may improve survival after surgical resection. Development of novel agents and improvement in neoadjuvant therapy is needed to improve outcomes in this aggressive disease.

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Linitis Plastica of The Stomach: A Review

Journal of Surgical Sciences ◽

10.3329/jss.v22i2.44231 ◽

2020 ◽

Vol 22 (2) ◽

pp. 125-138

Author(s):

Md Mizanur Rahman

Keyword(s):

Gastric Cancer ◽

Treatment Outcome ◽

Surgical Resection ◽

Linitis Plastica ◽

Diffuse Gastric Cancer ◽

Biological Behaviour ◽

Desmoplastic Reaction ◽

The Poor ◽

Diagnostic Approaches ◽

Poor Outcomes

Linitis plastica (LP) is a particular subtype of diffuse gastric cancer and is thought to have a separate entity in respect with its biological behaviour, pathology, presentation and treatment outcome. The poor prognosis of LP gastric cancer is due primarily to its advanced stage at diagnosis. The characteristic histopathological feature of this entity is cellular spread to the submucosa and stroma with minimal mucosal alterations accompanied by an excessive desmoplastic reaction. Despite recent research on alternative therapies, surgical resection appears the only potentially curative approach. Patient selection and multidisciplinary management are paramount when considering surgical resection in patients with gastric LP. The operative approach in patients with LP has historically been questioned because of the poor outcomes. The aim of this review is to highlight different dimension of linitis plastica stomach in respect to its definition, classification, clinico-pathological characters, diagnostic approaches and treatment outcome. Journal of Surgical Sciences (2018) Vol. 22 (2) : 125-138

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Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

Gastroenterology Research and Practice ◽

10.1155/2011/476014 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Chang-Ming Huang ◽

Jian-Xian Lin ◽

Chao-Hui Zheng ◽

Ping Li ◽

Jian-Wei Xie ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Lymph Nodes ◽

Distal Gastrectomy ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Prognostic Impact ◽

Term Survival

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated.Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III).Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended.

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Predictors of Survival in Adrenocortical Carcinoma: An Analysis From the National Cancer Database

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-00918 ◽

2018 ◽

Vol 103 (9) ◽

pp. 3566-3573 ◽

Cited By ~ 13

Author(s):

Sri Harsha Tella ◽

Anuhya Kommalapati ◽

Subhashini Yaturu ◽

Electron Kebebew

Keyword(s):

Surgical Resection ◽

Adrenocortical Carcinoma ◽

Poor Prognosis ◽

Stage Iv ◽

Tumor Grade ◽

Disease Stage ◽

Survival Outcomes ◽

National Cancer Database ◽

Stage Iv Disease ◽

Comorbidity Index

Abstract Context Adrenocortical carcinoma (ACC) is rare; knowledge about prognostic factors and survival outcomes is limited. Objective To describe predictors of survival and overall survival (OS) outcomes. Design and Patients Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2015 on 3185 patients with pathologically confirmed ACC. Main Outcome Measures Baseline description, survival outcomes, and predictors of survival were evaluated in patients with ACC. Results Median age at ACC diagnosis was 55 (range: 18 to 90) years; did not differ significantly by sex or stage of the disease at diagnosis. On multivariate analysis, increasing age, higher Charlson-Deyo comorbidity index score, high tumor grade, and no surgical therapy (all P < 0.0001); and stage IV disease (P = 0.002) and lymphadenectomy during surgery (P = 0.02) were associated with poor prognosis. Patients with stage I-III disease treated with surgical resection had significantly better median OS (63 vs 8 months; P < 0.001). In stage IV disease, better median OS occurred in patients treated with surgery (19 vs 6 months; P < 0.001), and postsurgical radiation (29 vs 10 months; P < 0.001) or chemotherapy (22 vs 13 months; P = 0.004). Conclusion OS varied with increasing age, higher comorbidity index, grade, and stage of ACC at presentation. There was improved survival with surgical resection of primary tumor, irrespective of disease stage; postsurgical chemotherapy or radiation was of benefit only in stage IV disease.

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Long-term results of surgical treatment of gastric cancer

Kazan medical journal ◽

10.17816/kazmj65314 ◽

1986 ◽

Vol 67 (2) ◽

pp. 104-106

Author(s):

A. S. Abdullin ◽

F. Sh. Akhmetzyanov ◽

A. A. Samigullin ◽

Z. N. Shemeunova ◽

V. A. Arinin ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Treatment ◽

Stomach Cancer ◽

Stage Iv ◽

Stage Ii ◽

Stage Iii ◽

Disease Stage ◽

Long Term Results ◽

Long Term Outcomes

We analyzed long-term outcomes of the treatment of 217 patients (men - 126, women - 91), who underwent radical operations for stomach cancer in the period of 1972 till 1976. 14 patients were under 39, 52 - from 40 to 49, 50 to 59 - 52, 60 to 69 - 80, over 70 years old - 19. The youngest patient was 28 years old and the oldest - 76 years old. Most patients (185) were operated on at stage III of the disease, stage II was diagnosed in 27 patients, and stage IV - in 5 patients.

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Is Linitis Plastica a Contraindication for Surgical Resection: A Multi-Institution Study of the U.S. Gastric Cancer Collaborative

Annals of Surgical Oncology ◽

10.1245/s10434-015-4947-8 ◽

2015 ◽

Vol 23 (4) ◽

pp. 1203-1211 ◽

Cited By ~ 12

Author(s):

Aaron U. Blackham ◽

Doug S. Swords ◽

Edward A. Levine ◽

Nora F. Fino ◽

Malcolm H. Squires ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Resection ◽

Linitis Plastica ◽

The U.S

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Expression of the Antiapoptosis Gene Survivin Predicts Poor Prognosis of Stage III Gastric Adenocarcinoma

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyp020 ◽

2009 ◽

Vol 39 (5) ◽

pp. 290-296 ◽

Cited By ~ 24

Author(s):

K. Y. Song ◽

C. K. Jung ◽

W. S. Park ◽

C. H. Park

Keyword(s):

Gastric Adenocarcinoma ◽

Poor Prognosis ◽

Stage Iii

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The Aberrant Expression of MicroRNA-125a-5p/IGF2BP3 Axis in Advanced Gastric Cancer and Its Clinical Relevance

Technology in Cancer Research & Treatment ◽

10.1177/1533033820917332 ◽

2020 ◽

Vol 19 ◽

pp. 153303382091733

Author(s):

Jing Zhang ◽

Fanghui Ding ◽

Dan Jiao ◽

Qiaozhi Li ◽

Hong Ma

Keyword(s):

Gastric Cancer ◽

Growth Factor ◽

Advanced Gastric Cancer ◽

Messenger Rna ◽

Poor Prognosis ◽

Rna Binding ◽

Binding Protein ◽

Rna Binding Protein ◽

Advanced Stage ◽

Insulin Like Growth Factor

RNA-binding proteins have been associated with cancer development. The overexpression of a well-known RNA-binding protein, insulin-like growth factor 2 messenger RNA–binding protein 3, has been identified as an indicator of poor prognosis in patients with various types of cancer. Although gastric cancer is a relatively frequent and potentially fatal malignancy, the mechanism by which insulin-like growth factor 2 messenger RNA–binding protein 3 regulates the development of this cancer remains unclear. This study aimed to investigate the role and regulatory mechanism of insulin-like growth factor 2 messenger RNA–binding protein 3 in gastric cancer. An analysis of IGF2BP3 expression patterns reported in 4 public gastric cancer–related microarray data sets from the Gene Expression Omnibus and The Cancer Genome Atlas-Stomach Adenocarcinoma revealed strong expression of this gene in gastric cancer tissues. Insulin-like growth factor 2 messenger RNA–binding protein 3 expression in gastric cancer was further confirmed via quantitative reverse transcription polymerase chain reaction and immunohistochemistry, respectively, in an in-house gastric cancer cohort (n = 30), and the association of insulin-like growth factor 2 messenger RNA–binding protein 3 expression with clinical parameters and prognosis was analyzed. Notably, stronger IGF2BP3 expression significantly correlated with poor prognosis, and significant changes in insulin-like growth factor 2 messenger RNA–binding protein 3 expression were only confirmed in patients with advanced-stage gastric cancer in an independent cohort. The effects of insulin-like growth factor 2 messenger RNA–binding protein 3 on cell proliferation were confirmed through in vitro experiments involving the HGC-27 gastric cancer cell line. MicroR-125a-5p, a candidate microRNA that target on insulin-like growth factor 2 messenger RNA–binding protein 3, decreased in advanced-stage gastric cancer. Upregulation of microR-125a-5p inhibited insulin-like growth factor 2 messenger RNA–binding protein 3, and dual-luciferase report assay indicated that microR-125a-5p inhibited the translation of IGF2BP3 by directly targeting the 3′ untranslated region. These results indicate that the microR-125a-5p/insulin-like growth factor 2 messenger RNA–binding protein 3 axis contributes to the oncogenesis of advanced gastric cancer.

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Long-term survival in advanced-stage uterine papillary serous carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5596 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5596-5596

Author(s):

Laura L. Holman ◽

David A. Iglesias ◽

Pamela T. Soliman ◽

Navdeep Pal ◽

Ann Klopp ◽

...

Keyword(s):

Stage Iii ◽

Serous Carcinoma ◽

Primary Therapy ◽

Advanced Stage ◽

Term Survival ◽

Study Objective ◽

Long Term Survival ◽

Uterine Papillary Serous Carcinoma ◽

Papillary Serous Carcinoma

5596 Background: Advanced-stage (III/IV) uterine papillary serous carcinoma (UPSC) has a median overall survival (OS) of ~ 3 yrs. The study objective was to determine factors associated with long-term survival in advanced stage UPSC. Methods: We performed a retrospective review of pts diagnosed with stage III or IV UPSC between 1993 and 2012. Summary statistics were used to describe demographic and clinical characteristics. OS was estimated with the Kaplan-Meier estimator. Fisher’s exact test and the Wilcoxon rank sum test were used to compare pts surviving >3 yrs with those surviving <1 yr. Results: With a median follow-up of 2.2 years (range 0.06-13.2), 262 pts with advanced stage UPSC were identified. The probability of surviving >3 yrs was 0.462, >4 yrs was 0.310, and >5 yrs was 0.228. Thirty-six (14%) pts survived >3 yrs and 37 (14%) survived <1 yr. There was no difference in median age of pts surviving >3 yrs compared to pts surviving <1 yr (60 vs 66, p=0.21). There was also no difference between groups in demographics or medical history. There were several significant differences in pathologic and treatment variables between groups (Table). Conclusions: Though rare, long-term survival in advanced stage UPSC is associated with mixed histology, combination treatment including chemotherapy, and complete response to primary therapy. Further study of the molecular basis for these differences has the potential to improve survival for all pts with this disease. [Table: see text]

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