Department of Surgical Oncology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
Division of Frontier Medical Science, Department of Surgery, Graduate School of Biomedical Sciences Hiroshima University, Hiroshima, Japan.
Gastric Cancer. 2018 Mar;21(2):315-323. doi: 10.1007/s10120-017-0738-1. Epub 2017 Jun 14.
A retrospective study was performed to clarify the role of conversion therapy (surgery with a prospect of R0 resection performed in initially unresectable metastatic cancer that responded to the chemotherapy) in stage IV gastric cancer (GC).
We treated 259 stage IV GC patients with systemic chemotherapy at Gifu and Hiroshima University Hospitals between 2001-2013. Of these, 84 patients who were subsequently treated by surgery were classified into four categories according to our previously published classification of stage IV GC, and short- and long-term outcomes were analyzed.
Surgery was performed in 84 patients, of which 7 were performed following the neoadjuvant chemotherapy, whereas the other 77 that excluded neoadjuvant chemotherapy cases were considered the conversion therapy. The postoperative mortality and morbidity were comparable with those reported clinical trials. The MSTs of the patients with/without surgery for each category were 28.3/5.8 months for category 1, 30.5/11.0 months for category 2, 31.0/18.5 months for category 3 and 24.7/10.0 months for category 4. The MST of the R0 resected patients (41.3 months) was far better than that of the R1-2 resected patients (21.2 months). The MSTs of the patients with R0/R1-2 resection were 56.2/16.3 months for category 2, 33.3/29.6 months for category 3 and 40.7/17.8 months for category 4.
There were long-term survivors who underwent conversion therapy for stage IV GC. Adequate selection of stage IV GC patients for conversion therapy may be an important role for the surgical oncologist in the new era.
本回顾性研究旨在阐明转化治疗（最初不可切除的转移性癌症在化疗后反应良好，然后进行手术以达到 R0 切除的可能性）在 IV 期胃癌（GC）中的作用。
我们在 2001 年至 2013 年期间在岐阜大学医院和广岛大学医院治疗了 259 例 IV 期 GC 患者，其中 84 例患者随后接受了手术治疗。根据我们之前发表的 IV 期 GC 分类，将这 84 例患者分为四类，并分析了短期和长期结果。
84 例患者接受了手术治疗，其中 7 例在新辅助化疗后进行，而其他 77 例排除新辅助化疗的病例被认为是转化治疗。术后死亡率和发病率与临床试验报道的相似。每种类别中接受/未接受手术的患者的 MST 分别为：1 类患者为 28.3/5.8 个月，2 类患者为 30.5/11.0 个月，3 类患者为 31.0/18.5 个月，4 类患者为 24.7/10.0 个月。R0 切除患者的 MST（41.3 个月）明显优于 R1-2 切除患者（21.2 个月）。R0/R1-2 切除患者的 MST 分别为：2 类患者为 56.2/16.3 个月，3 类患者为 33.3/29.6 个月，4 类患者为 40.7/17.8 个月。
IV 期 GC 患者接受转化治疗后有长期生存者。对于外科肿瘤学家来说，在新时代对 IV 期 GC 患者进行适当的转化治疗选择可能是一项重要的角色。
