Kawamoto Makoto, Onishi Hideya, Koya Norihiro, Konomi Hiroyuki, Mitsugi Kenji, Tanaka Risa, Motoshita Junichi, Morisaki Takashi, Nakamura Masafumi
Department of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Case Rep. 2017 Oct 23;3(1):112. doi: 10.1186/s40792-017-0380-5.
The prognosis of stage IV gastric cancer (GC) still remains unfavorable. Multidisciplinary approaches should therefore be considered to improve the survival of patients with stage IV GC. We report here a case of primary GC with potentially unresectable metastasis, successfully treated by a multidisciplinary approach including chemotherapy, immunotherapy, and surgery.
A 74-year-old man presented with multiple left neck masses. Abdominal computed tomography showed a thickened gastric wall and multiple lymphadenopathies including left supraclavicular lymph node. Gastroenterological endoscopy revealed tumor lesions in the gastric cardia. Tumor biopsy indicated a pathological diagnosis of poorly differentiated adenocarcinoma. Open left cervical lymph node biopsy showed histological features identical with the gastric tumor, indicating left clavicle lymph node metastasis of GC. After 2 years of chemo-immunotherapy with S-1/CDDP, paclitaxel, and cytokine-activated killer cells, lesions other than the stomach lesion had regressed to undetectable on imaging studies. The patient then underwent laparoscopy-assisted total gastrectomy with Roux-en-Y reconstruction followed by adjuvant chemo-immunotherapy with paclitaxel and S-1 for 1 year, and immunotherapy with tumor lysate-pulsed dendritic cell-activated killer cells for 5 years. The patient remained well after 5 years and 6 months of follow-up, with no signs of recurrence.
Therapeutic combinations including immunotherapy may thus allow surgery to be performed in patients previously considered unsuitable for surgical intervention, potentially leading to a clinical cure, as in the current case.
IV期胃癌（GC）的预后仍然不容乐观。因此，应考虑采用多学科方法来提高IV期GC患者的生存率。我们在此报告一例原发性GC伴潜在不可切除转移灶的病例，通过包括化疗、免疫治疗和手术在内的多学科方法成功治疗。
一名74岁男性出现左侧颈部多个肿块。腹部计算机断层扫描显示胃壁增厚以及包括左锁骨上淋巴结在内的多个淋巴结病变。胃肠内镜检查发现贲门部有肿瘤病变。肿瘤活检病理诊断为低分化腺癌。左侧颈部开放性淋巴结活检显示组织学特征与胃肿瘤相同，提示GC左锁骨上淋巴结转移。在使用S-1/顺铂、紫杉醇和细胞因子激活的杀伤细胞进行2年的化疗免疫治疗后，除胃部病变外的其他病变在影像学检查中已消退至无法检测到。然后患者接受了腹腔镜辅助全胃切除术及Roux-en-Y重建术，随后接受了1年的紫杉醇和S-1辅助化疗免疫治疗，以及5年的肿瘤裂解物脉冲树突状细胞激活的杀伤细胞免疫治疗。经过5年6个月的随访，患者情况良好，无复发迹象。
因此，包括免疫治疗在内的治疗组合可能使先前被认为不适合手术干预的患者能够接受手术，有可能实现临床治愈，如本例所示。
