Koufuji Kikuo, Aoyagi Keishirou, Yano Shojirou, Murakami Naotaka, Miyagi Motosi, Imaizumi Takuya, Shirouzu Kazuo
Dept. of Surgery, Kurume University School of Medicine.
Gan To Kagaku Ryoho. 2005 Oct;32(10):1384-8.
We examined 198 cases of primary scirrhous type 4 gastric cancer at our department from 1984 to 2003. Of these, 139 cases underwent gastrectomy. The essential cause of inoperability was peritoneal dissemination with malignant abdominal abscises. The incidence of peritoneal dissemination was 48.2% of all resected cases. The 5-year survival rate of all resected cases was 12% and that of non-resectable cases was 0%. One of the 59 nonresectable cases who responded remarkably to treatment by TS-1/paclitaxel combination chemotherapy obtained survival of 12 months. Six cases with peritoneal dissemination were treated by chemotherapy with cisplatin and etoposide infused intra-peritoneally and 2 of them were diagnosed as P 0 after 4 weeks. One case with type 4 gastric cancer who had right hydronephrosis and malignant abdominal ascites underwent curative resection after successful treatment with TS-1. We have selected the way of conventional chemotherapy for inoperable type 4 gastric cancers, but the prognosis is still poor. It is thought necessary to improve survival by newly developed anticancer agents such as TS-1, etoposide and taxanes. Immuno-cellular therapy with autologous tumor cell stimulated lymphocyte may be examined as a neo-adjuvant therapy as well as chemotherapy.
1984年至2003年期间，我们科室对198例原发性4型硬化型胃癌进行了检查。其中，139例行胃切除术。无法手术的主要原因是伴有恶性腹腔脓肿的腹膜播散。腹膜播散的发生率在所有切除病例中为48.2%。所有切除病例的5年生存率为12%，不可切除病例的5年生存率为0%。59例不可切除病例中有1例对TS-1/紫杉醇联合化疗反应显著，存活了12个月。6例腹膜播散患者接受了顺铂和依托泊苷腹腔内灌注化疗，其中2例在4周后被诊断为P 0。1例伴有右肾积水和恶性腹腔积液的4型胃癌患者在接受TS-1成功治疗后接受了根治性切除术。对于无法手术的4型胃癌，我们选择了传统化疗方法，但预后仍然很差。人们认为有必要通过新开发的抗癌药物如TS-1、依托泊苷和紫杉烷来提高生存率。自体肿瘤细胞刺激淋巴细胞的免疫细胞治疗作为新辅助治疗以及化疗都可以进行研究。
