Hiraki Masatsugu, Sato Seiji, Kai Keita, Ohtsuka Takao, Kohya Naohiko, Kitajima Yoshihiko, Nakafusa Yuji, Tokunaga Osamu, Miyazaki Kohji
Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Department of Pathology and Biodefense, Saga University Faculty of Medicine, Saga, Japan.
Clin J Gastroenterol. 2009 Oct;2(5):331-337. doi: 10.1007/s12328-009-0105-9. Epub 2009 Sep 9.
A 67-year-old male with advanced gastric cancer and lymph node metastasis as well as a tumor embolus in the portal vein was treated by S-1/cisplatin therapy. The serum alpha-fetoprotein levels were elevated to 836 ng/ml at the first visit. After one course of chemotherapy, the patient showed stable disease; the serum level of alpha-fetoprotein also decreased to 626 ng/ml after a transient increase, and therefore reduction surgery was performed. A total gastrectomy with a distal pancreatectomy, splenectomy, and regional lymph node dissection was performed. The resected specimen was diagnosed to be alpha-fetoprotein-producing gastric cancer. There were no metastatic foci in the resected lymph nodes, presumably due to the preoperative chemotherapy. S-1/cisplatin therapy was continued after the operation to treat the remaining tumor embolus in the portal vein. After one course of this therapy, the tumor embolus disappeared. However, a lymph node measuring 1.5 cm in diameter appeared in the hepatoduodenal ligament. Therefore, the chemotherapy was changed to paclitaxel monotherapy. After 2 courses of paclitaxel monotherapy, the lymph node swelled, and thus 5'-deoxy-5-fluorouridine was added to the paclitaxel regimen. After 5 courses of this regimen, the lymph node swelling disappeared without any other new lesions and a total of 21 courses were performed. The patient remained stable for over 8 years without recurrence. The expression of chemoresistance-related proteins was retrospectively analyzed by immunohistochemistry to evaluate the chemoresistance. The ortate phosphoribosyltransferase expression was strongly positive, and the good outcome in this case may have been associated with this result.
一名67岁男性，患有晚期胃癌并伴有淋巴结转移以及门静脉肿瘤栓子，接受了S-1/顺铂治疗。初诊时血清甲胎蛋白水平升高至836 ng/ml。经过一个疗程的化疗，患者病情稳定；血清甲胎蛋白水平在短暂升高后也降至626 ng/ml，因此进行了减瘤手术。实施了全胃切除术，同时切除远端胰腺、脾脏并进行区域淋巴结清扫。切除标本被诊断为产生甲胎蛋白的胃癌。切除的淋巴结中未见转移灶，推测是由于术前化疗的缘故。术后继续进行S-1/顺铂治疗以处理门静脉中残留的肿瘤栓子。经过一个疗程的这种治疗，肿瘤栓子消失。然而，在肝十二指肠韧带处出现了一个直径1.5 cm的淋巴结。因此，化疗改为紫杉醇单药治疗。经过2个疗程的紫杉醇单药治疗后，淋巴结肿大，于是在紫杉醇治疗方案中加入5'-脱氧-5-氟尿苷。经过5个疗程的该方案治疗后，淋巴结肿大消失，未出现任何其他新病灶，共进行了21个疗程的治疗。患者病情稳定超过8年未复发。通过免疫组织化学回顾性分析化疗耐药相关蛋白的表达以评估化疗耐药情况。乳清酸磷酸核糖基转移酶表达呈强阳性，该病例的良好预后可能与此结果有关。
