Suda Kazuyoshi, Kameyama Hitoshi, Shimada Yoshifumi, Sakata Jun, Kobayashi Takashi, Nogami Hitoshi, Minagawa Masahiro, Kosugi Shinichi, Koyama Yu, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.
Gan To Kagaku Ryoho. 2014 Nov;41(12):1572-4.
Herein, we present a case of advanced rectal cancer surgically resected after chemotherapy. A 65-year-old woman presented with anal pain, and rectal cancer extending beyond the anus was diagnosed. The primary tumor was a well-differentiated adenocarcinoma with a KRAS mutation. Computed tomography revealed cancer invasion into the vagina and sacral and coccygeal bones, and cancer metastases to the bilateral inguinal lymph nodes and the left lung. Sigmoid colostomy and subcutaneous venous port insertion were performed. The patient was treated with modified oxaliplatin, leucovorin, and 5- fluorouracil (FOLFOX6) plus bevacizumab. She showed a partial response according to the Response Evaluation Criteria in Solid Tumors after 13 courses of chemotherapy. The primary tumor was then resected via posterior pelvic exenteration, bilateral inguinal lymphadenectomy, and sacral/coccygeal resection. Histological examination of the resected specimens revealed moderately differentiated adenocarcinoma with vaginal invasion. Metastasis to a right inguinal lymph node was observed. The pathological stage was ypT4bN0M1b, ypStage IV according to the tumor-node-metastasis system of the eighth edition of the Japanese Classification of Colorectal Carcinoma. The pathological response grade of the tumor after chemotherapy was determined to be Grade 1b.
在此，我们报告一例经化疗后接受手术切除的晚期直肠癌病例。一名65岁女性因肛门疼痛就诊，被诊断为直肠癌已侵犯至肛门以外。原发肿瘤为具有KRAS突变的高分化腺癌。计算机断层扫描显示癌组织侵犯阴道、骶骨和尾骨，且癌转移至双侧腹股沟淋巴结及左肺。遂行乙状结肠造口术及皮下静脉置管术。患者接受了改良奥沙利铂、亚叶酸钙和5-氟尿嘧啶（FOLFOX6）联合贝伐单抗治疗。化疗13个疗程后，根据实体瘤疗效评价标准，她显示出部分缓解。随后通过后盆腔脏器清除术、双侧腹股沟淋巴结清扫术及骶骨/尾骨切除术切除原发肿瘤。切除标本的组织学检查显示为中度分化腺癌伴阴道侵犯。观察到右侧腹股沟淋巴结转移。根据日本结直肠癌分类第八版的肿瘤-淋巴结-转移系统，病理分期为ypT4bN0M1b，ypIV期。化疗后肿瘤的病理反应分级确定为1b级。
