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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E467: Contemporary Trends, Management, and Outcomes for Patients with Diffuse Type Gastric Cancer

Introduction: Diffuse type gastric cancer (GC) is a distinct form of gastric adenocarcinoma traditionally associated with poor prognosis. While National Comprehensive Cancer Network (NCCN) guidelines recognize that histologic type may have implications for therapy, specific recommendations for diffuse type GC are lacking. Herein, we aimed to characterize contemporary trends, management, and outcomes for patients with diffuse type GC compared to the more prevalent intestinal type GC.

Methods: The National Cancer Database (NCDB) was queried for patients diagnosed with diffuse and intestinal type GC from 2004-2019. Patients with adenocarcinoma not otherwise specified were excluded. Patients were stratified by GC type, then demographics, tumor characteristics, management, and outcomes were compared. Survival analysis was performed using the Kaplan-Meier method.

Results: Altogether, 22,295 patients met study criteria: 7,694 (34.5%) with diffuse and 14,601 (65.5%) with intestinal type GC. During the study period, GC cases increased annually in the NCDB with no significant difference in the proportion of diffuse type (Figure A). At presentation, patients with diffuse type GC were more likely to be younger (median 65 vs. 73 years), female (48.4% vs. 34.7%), and white (69.4% vs. 63%), with later stage disease (26.9% vs. 18% clinical stage IV) and larger tumors (median 4.6 vs. 4 cm) compared to those with intestinal type (all p< 0.05). Accordingly, patients with diffuse type GC were less likely to undergo surgical intervention (59.1% vs. 66.3%, p< 0.001) and more likely to receive systemic chemotherapy (56.5% vs. 44.8%, p< 0.001). Among patients undergoing resection, those with diffuse type more commonly had a total gastrectomy (34.8% vs. 20.6%), greater nodal harvest (median 17 vs. 16 nodes), higher rates of nodal positivity (66.9% vs. 49.2%) and positive margins (28.6% vs. 9.1%) (all p< 0.05). Diffuse type was associated with worse 5-year overall survival compared to intestinal type (21.9% vs. 36.5%, log-rank p< 0.0001; Figure B). This survival difference was preserved in subgroups by clinical stage. Among patients with diffuse type GC, surgery was associated with greater overall survival (33.0% vs. 4.7% log-rank p< 0.0001; Figure C).

Conclusions: In the current era, diffuse type GC remains distinct from intestinal type GC in patient presentation, management, and outcomes. Further study is needed to improve early detection, management, and prognosis of diffuse type GC. 

Learning Objectives:

  • Upon completion, participant will be able to recognize histologic variants of gastric cancer
  • Upon completion, participant will be able to recognize differences in management for diffuse type gastric cancer
  • Upon completion, participant will be able to recognize differences in outcomes for diffuse type gastric cancer