Ebisui Chikara, Hamano Rie, Minoji Takayuki, Kitahara Tomohiro, Yanagisawa Tetsu, Okamura Shu, Fukuchi Nariaki, Murata Kohei, Yokouchi Hideoki, Kinuta Masakatsu, Ohishi Kazuhito
Dept. of Surgery, Suita Municipal Hospital.
Gan To Kagaku Ryoho. 2017 Nov;44(12):1263-1265.
A 67-year-old man was admitted to our hospital because of anemia and weight loss, and diagnosed with a type 3 tumor in the upper gastric body. Pathological examination suggested moderately differentiated adenocarcinoma with immunohistochemically negative staining for HER2. Abdominal CT revealed thickening of the gastric wall and multiple liver metastases. The clinical findings suggested Stage IV disease(T4aN0M1). Chemotherapy was administered with a combination of S-1 plus CDDP(SP). However, the level of CEA(ng/mL)increased from 49.2 to 634.6, and the treatment schedule was changed to a combination of S-1 plus oxaliplatin(SOX). After 3 courses of the SOX regimen, abdominal CT showed a reduction of liver metastases and the level of CEA decreased to 8.4 ng/mL. We performed total gastrectomy with D1 lymph node dissection in September 2016. Post-operative pathological findings were ypStage IV (T3N0M1)and chemotherapeutic effect was grade 2. CT scan revealed regrowth of the tumor in S2 3 months after the operation. The patient underwent transcatheter arterial chemoembolization(TACE)followed by a regimen of paclitaxel plus ramucirumab(PTX/RAM). At present, he is being treated with the PTX/RAM regimen in the outpatient department with no signs of tumor growth. Although the prognosis of gastric cancer with synchronous liver metastases is very poor, it is possible for survival to be prolonged with multimodality therapy.
一名67岁男性因贫血和体重减轻入院，被诊断为胃体上部3型肿瘤。病理检查提示为中分化腺癌，HER2免疫组化染色阴性。腹部CT显示胃壁增厚及多发肝转移。临床检查结果提示为IV期疾病（T4aN0M1）。采用S-1联合顺铂（SP）进行化疗。然而，癌胚抗原（CEA，ng/mL）水平从49.2升至634.6，治疗方案改为S-1联合奥沙利铂（SOX）。经过3个疗程的SOX方案治疗后，腹部CT显示肝转移灶缩小，CEA水平降至8.4 ng/mL。2016年9月，我们为患者实施了D1淋巴结清扫的全胃切除术。术后病理结果为ypIV期（T3N0M1），化疗效果为2级。术后3个月CT扫描显示S2段肿瘤复发。患者接受了经动脉化疗栓塞术（TACE），随后采用紫杉醇联合雷莫西尤单抗（PTX/RAM）方案。目前，他正在门诊接受PTX/RAM方案治疗，未出现肿瘤生长迹象。虽然伴有同时性肝转移的胃癌预后很差，但通过多模式治疗有可能延长生存期。
