Abstract:
Background: The prognostic value of neoadjuvant therapy (NAT) in patients with gastric linitis plastica (GLP) remained controversial. This study aimed to analyze the effect of NAT therapy on short- and long-term patients with GLP.
Methods: This multi-center study enrolled patients with GLP who underwent surgical resection at the China National Cancer Center, The First Hospital of Lanzhou University, Lanzhou University Second Hospital, and Gansu Provincial Cancer Hospital between 2000 and 2020. All patients included were divided into two groups, neoadjuvant therapy followed by radical gastrectomy (NAT group) and upfront radical gastrectomy (upfront surgery group).
Results: Totally, 496 patients were included in this study (131 of NAT group and 365 of upfront surgery group). Compared to the upfront surgery group, patients in the NAT group tended to present with more extensive lesions at diagnosis (cT4 stage, 88.5% vs. 72.1%, p=0.001), but a less extensive range of lymph node metastasis (cN3 stage: 28.0% vs. 58.9%, p<0.001). As for short-term outcomes, we found that early postoperative complications were similar between NAT and upfront surgery groups (3.8% vs. 9.0%, p=0.054). The median overall survival (OS) of the NAT group and upfront surgery group was 30.9 vs. 26.9 months, respectively (p=0.42). The median progression-free survival (PFS) of the NAT group and upfront surgery group was 23.6 vs. 22.8 months, respectively (p=0.642). In multivariable COX analysis, NAT was not associated with improved OS (HR=1.342, 95%CI [0.881-2.045], p=0.17) and PFS (HR=1.46, 95%CI [0.967-2.204], p=0.072).
Conclusion: In conclusion, NAT might not improve the long-term survival of patients with non-metastatic GLP. Randomized controlled trials need to be conducted to examine this issue further.
