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Han Y, Xuan Y, Liu X, Zhu H, Zhang M, Xu D, Wang Y, Cai H. Development of a Quantitative Diagnostic Criterion for Gastric Linitis Plastica: Findings From a Large Single-Institutional Study. Front Oncol 2021; 11:683608. [PMID: 34422637 PMCID: PMC8377468 DOI: 10.3389/fonc.2021.683608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/15/2021] [Indexed: 01/17/2023] Open
Abstract
Gastric linitis plastica (GLP) is a descriptive term but lacks a quantitative definition. Several relatively quantitative criteria had been proposed, such as tumor involving a limit of one-third or two-thirds of the gastric surface. However, these criteria needed doctors to subjectively judge tumor infiltration area, which made diagnosis difficult to be objective and reproducible. This study aimed to propose a quantitative diagnostic criterion for distinguishing GLP. We performed a retrospective cohort study of 2,907 patients with Borrmann III and IV gastric cancer (GC) who underwent gastrectomy between 2011 and 2018 in our center. The Kaplan–Meier curves showed that patients with an observed tumor size more than 8 cm had obviously lower overall survival (OS) and disease-free survival (DFS) rates than those with a size less than 8 cm(p < 0.001; p < 0.001). However, there was no significantly different prognosis of patients with tumor sizes between more than 8 cm and more than 10 cm (p = 0.248; p = 0.534). Moreover, patients with tumor sizes greater than 8 cm more presented with advanced stage and had extremely poor 3-year OS and DFS (31.4%; 29.3%), with a stronger propensity toward peritoneal metastasis. Therefore, we considered patients’ observed tumor size more than 8 cm as a critical value for distinguishing the prognosis of Borrmann III and IV GC. Furthermore, we proposed an observed tumor size more than 8 cm as a quantitative diagnostic criterion for GLP on the premise of satisfying the originally descriptive and pathological definition regardless of Borrmann type.
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Affiliation(s)
- Yang Han
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Xuan
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaowen Liu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Meng Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dazhi Xu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yanong Wang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Cai
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Song XH, Zhang WH, Kai-Liu, Chen XL, Zhao LY, Chen XZ, Kun-Yang, Zhou ZG, Hu JK. Prognostic impact of Borrmann classification on advanced gastric cancer: a retrospective cohort from a single institution in western China. World J Surg Oncol 2020; 18:204. [PMID: 32792016 PMCID: PMC7427284 DOI: 10.1186/s12957-020-01987-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background Due to the controversy over the prognostic significance of Borrmann type in patients with gastric cancer (GC), the present study was to investigate the clinical value of Borrmann type in advanced GC. Methods We retrospectively evaluated 2092 patients with advanced GC and subsequently examined the clinicopathological characteristics and prognosis of patients stratified by Borrmann type. Results Patients were divided into three groups according to Borrmann type (Borrmann types I+II, III, and IV). Patients with Borrmann types III and IV had larger size, more poorly differentiated tumor type, more advanced tumor stage, and higher chance of involving the entire stomach. The overall survival (OS) rates were significantly different among the three groups (p < 0.001). Stratification analysis revealed significant OS rates among the three groups in tumor-node-metastasis (TNM) stage III (p < 0.001) and TNM stage IV (p = 0.008). Multivariate analysis revealed that Borrmann types, adjuvant chemotherapy, curative resection, and TNM stage were all independent predictors of OS among GC patients. The subgroup analysis indicated that Borrmann type was an independent predictor of OS among GC patients who undergone curative resection and with TNM stage III cancer. However, curative resection and postoperative chemotherapy failed to prolong the survival of patients with Borrmann type IV. Conclusions The clinicopathological characteristics and prognosis of patients with three Borrmann types of GC were different. Borrmann type can be simply used as a valuable factor to predict survival in advanced GC patients, especially in those TNM stage III undergoing curative resection. Additionally, more attention should be paid to the treatment for Borrmann type IV GC.
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Affiliation(s)
- Xiao-Hai Song
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Kai-Liu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Lin-Yong Zhao
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Kun-Yang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery and Laboratory of Digestive Surgery, Institute of Digestive Surgery and State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China.
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Endoscopic ultrasound-guided fine-needle aspiration biopsy for diagnosis of gastric linitis plastica with negative malignant endoscopy biopsies. Oncol Lett 2018; 16:4915-4920. [PMID: 30250557 PMCID: PMC6144711 DOI: 10.3892/ol.2018.9258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/17/2018] [Indexed: 12/12/2022] Open
Abstract
The value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy in the gastric linitis plastica (GLP) with negative malignant endoscopy biopsies was investigated. Forty-six patients with linitis plastica who had undergone EUS-FNA were retrospectively studied, and their clinicopathological data were examined. Among the 46 eligible patients, 38 cases were diagnosed clearly by EUS-FNA. There were 24 cases with lymph node metastasis in the 38 patients. Both the lymph nodes and gastric lesions were punctured by EUS-FNA in the 24 cases. We compared the diagnostic accuracy in different sites, and the results showed that the diagnostic accuracy in lymph nodes was significantly higher than that in gastric lesions (P<0.05). Among them, 16 patients underwent surgical resection, and the accuracy of the pathological diagnosis by EUS-FNA was 87.5% (14/16). The preoperative diagnostic accuracy of T and N staging by endoscopic ultrasound (EUS) were both 75%. Neither severe hemorrhage nor perforation occurred in any patient. In conclusion, EUS-FNA is a safe and effective procedure for the diagnosis of indefinite linitis plastica, and puncturing metastatic lymph nodes can improve the diagnostic accuracy.
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Yavorkovsky LL, Ali S. Image Diagnosis: A Gastric Signet-Ring Adenocarcinoma of Type Linitis Plastica Mimicking Splenomegaly in a Patient with Chronic Lymphocytic Leukemia. Perm J 2017; 21:16-144. [PMID: 28609263 DOI: 10.7812/tpp/16-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Shazia Ali
- Gastroenterologist at the San Jose Medical Center in CA.
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Blackham AU, Swords DS, Levine EA, Fino NF, Squires MH, Poultsides G, Fields RC, Bloomston M, Weber SM, Pawlik TM, Jin LX, Spolverato G, Schmidt C, Worhunsky D, Cho CS, Maithel SK, Votanopoulos KI. Is Linitis Plastica a Contraindication for Surgical Resection: A Multi-Institution Study of the U.S. Gastric Cancer Collaborative. Ann Surg Oncol 2015; 23:1203-11. [PMID: 26530447 DOI: 10.1245/s10434-015-4947-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Aaron U Blackham
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Doug S Swords
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nora F Fino
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Mark Bloomston
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda X Jin
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Gaya Spolverato
- Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl Schmidt
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David Worhunsky
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Clifford S Cho
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Endo K, Sakurai M, Kusumoto E, Uehara H, Yamaguchi S, Tsutsumi N, Ikejiri K. Biological significance of localized Type IV scirrhous gastric cancer. Oncol Lett 2011; 3:94-99. [PMID: 22740862 DOI: 10.3892/ol.2011.454] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/11/2011] [Indexed: 12/14/2022] Open
Abstract
The prognosis of type IV scirrhous gastric cancer (SGC) is extremely poor. Linitis plastica (LP), the so-called 'leather bottle stomach', is believed to be a typical case of SGC, which is usually diagnosed as a far-advanced gastric cancer. The pathogenesis of this disease remains unclear. Although typical SGC often invades the entire stomach, atypical cases show SGC localized to one region of the stomach. The aim of the present study was to investigate localized SGC (LSGC) and its biological significance. A total of 509 patients with advanced gastric cancer who underwent gastrectomy were evaluated. These patients were divided into three groups as follows: 19 patients with type IV scirrhous lesions invading the whole stomach (defined as LP), 60 patients with type IV scirrhous lesions localized in less than two thirds of the stomach (defined as LSGC) and the remaining 430 patients with all other types of gastric cancer (OGC), and then clinicopathologically compared. Results showed that LP had deeper invasion (p=0.006), more frequent peritoneal dissemination including positive cytology (p=0.01 and p=0.018) and lower curability (p=0.03) compared with LSGC, whereas LSGC showed a higher malignant potential in a number of clinicopathological factors compared with OGC. Univariate analysis showed that survival in patients with LP was significantly poorer than in those with LSGC (p=0.002) whose survival was, in turn, inferior to those with OGC. By contrast, LSGC was not a prognostic factor in SGC according to the multivariate analysis. The findings of this study suggested that the malignant status of LSGC differs from that of LP, and that curative gastrectomy is effective in improving the outcome for LSGC but not for LP, as LSGC may represent the prelinitis condition.
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Affiliation(s)
- Kazuya Endo
- Department of Surgery, Center for Gastroenterology, Fukuoka 810-8563, Japan
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Schauer M, Peiper M, Theisen J, Knoefel W. Prognostic factors in patients with diffuse type gastric cancer (linitis plastica) after operative treatment. Eur J Med Res 2011; 16:29-33. [PMID: 21345767 PMCID: PMC3351946 DOI: 10.1186/2047-783x-16-1-29] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Treatment options for patients with diffuse type gastric cancer (linitis plastica) are discussed controversial. It is sometimes discussed that these patients should be treated primarily in palliative intention conservative without resection. Methods In a single-center analysis, we investigated 120 patients with diffuse type gastric cancer. All patients underwent a total gastrectomy, 45 patients even a multivisceral resection because of infiltrating growth, or metastases. Serum tumor marker CEA, CA 72-4, and CA 19-9 were recorded in all patients before surgery. An immunocytochemical detection of free peritoneal tumor cells (FPTC) using Ber-EP4 antibody was correlated with tumor stage and survival. Median follow-up time was 38 months. Results Complete resection rate was 31% (n = 37). 61% (n = 73) of all patients had already distant metastases at the time of surgery, 80% of them peritoneal carcinomatosis. Median survival for the whole group was 8 months, after complete resection 17 months. Lavage cytology, distant metastases, resection rate, and CA19-9 levels had significant influence on survival. Conclusion A significant survival advantage for patients with diffuse type gastric cancer can only be achived after complete resection. We could define a subset of patients with an extremely poor prognosis even after surgical resection. Meticulous preoperative staging, including a diagnostic laparoscopy to exclude peritoneal carcinomatosis and free peritoneal tumor cells before resection should be mandatory in these patients.
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Affiliation(s)
- M Schauer
- Department of General-, Visceral-, and Pediatric Surgery, Universitaetsklinikum Duesseldorf, Heinrich Heine Universitaet, Moorenstrasse 5, 40225 Duesseldorf, Germany.
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Borrmann type IV: an independent prognostic factor for survival in gastric cancer. J Gastrointest Surg 2008; 12:1364-9. [PMID: 18516653 DOI: 10.1007/s11605-008-0516-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 03/26/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Borrmann type IV gastric cancer has a poorer prognosis than other gastric carcinomas. This study compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of cancer and examined the significance of a Borrmann type IV carcinoma as a prognostic factor after gastrectomy. METHODS The clinicopathological features, tumor-node-metastasis (TNM) stage, and survival rates of 4,191 advanced gastric cancer patients, who had undergone a gastrectomy at the Samsung Medical Center between 1995 and 2005, were reviewed. RESULTS Borrmann type IV gastric cancer was found to be associated with more advanced and unfavorable clinicopathological features at diagnosis than the other cancers. The 5-year survival rate of the patients with Borrmann type IV cancer was 27.6%. In contrast, the 5-year survival rate of patients with the other types of cancer was 61.2%. The 5-year survival rate for each stage of Borrmann type IV gastric cancer and the other type gastric cancer was 61.0% and 88.8% for stage Ib (P < 0.001), 49.8% and 76.1% for stage II (P < 0.001), 36.4% and 55.1% for stage IIIa (P < 0.001), 15.2% and 38.5% for stage IIIb (P = 0.001), and 10.2% and 20.1% for stage IV (P = 0.008), respectively. Multivariate analyses revealed a Borrmann type IV carcinoma, the surgical extent, curability, tumor stage, including T, N, and M status, and adjuvant therapy to be independent prognostic factors for survival. CONCLUSION A Borrmann type IV carcinoma has unique clinicopathological features compared with other types of gastric carcinomas and is an important independent prognostic factor.
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