Namikawa Tsutomu, Ishida Nobuko, Tsuda Sachi, Fujisawa Kazune, Munekage Eri, Iwabu Jun, Munekage Masaya, Uemura Sunao, Tsujii Shigehiro, Maeda Hiromichi, Kitagawa Hiroyuki, Kobayashi Michiya, Hanazaki Kazuhiro
Department of Surgery, Kochi Medical School, Kochi, Japan
Department of Surgery, Kochi Medical School, Kochi, Japan.
In Vivo. 2018 Sep-Oct;32(5):1211-1216. doi: 10.21873/invivo.11366.
A pathological complete response (pCR) to treatment for gastric cancer is a rare event, even when powerful treatment regimens are used. Herein, a case of 61-year-old male referred to our hospital with advanced gastric cancer who achieved a pCR following chemotherapy using S-1, and subsequently underwent total gastrectomy is reported. His initial esophagogastroduodenoscopy (EGD) revealed an irregular, nodular, ulcerated lesion in the upper third of the stomach that was analyzed by biopsy to be a moderately differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography (CT) showed gastric wall thickening and lymph node swelling in the perigastric area. The patient was clinically diagnosed with cT3N1M0, stage IIB advanced gastric cancer. The patient decided against curative surgery due to his work circumstances and was started on S-1 (80 mg/m) chemotherapy administered orally twice a day for 4 weeks, followed by 2 weeks of no chemotherapy. After four such courses of systemic S-1 chemotherapy, EGD showed a small, reddened lesion with aggregated, whitish lines. The gastric wall thickening and lymphadenopathy in the perigastric area were also reduced remarkably. The patient subsequently agreed to surgery, undergoing total gastrectomy with D2 lymphadenectomy. Gross examination of the surgically resected specimen showed a slightly erythrogenic, flat lesion measuring 1.5×1.0 cm. Pathological examination of the resected specimen and harvested lymph nodes detected no malignant cells. The postoperative course was uneventful. The patient has continued to receive S-1 chemotherapy, with no evidence of recurrence at 4 months post-surgery. To the best of our knowledge, this is only the second case of a gastric cancer patient achieving a pCR by S-1 monotherapy reported in the English literature and indicates the potential adoption of curative resection after S-1 chemotherapy as a treatment strategy for advanced gastric cancer.
即使使用强效治疗方案，胃癌治疗后达到病理完全缓解（pCR）的情况也很罕见。在此，报告一例61岁男性晚期胃癌患者，该患者使用S-1化疗后实现了pCR，随后接受了全胃切除术。他最初的食管胃十二指肠镜检查（EGD）显示胃上三分之一处有一个不规则、结节状、溃疡病变，活检分析为中分化腺癌。腹部增强计算机断层扫描（CT）显示胃壁增厚和胃周区域淋巴结肿大。该患者临床诊断为cT3N1M0，IIB期晚期胃癌。由于工作原因，患者决定不接受根治性手术，开始口服S-1（80mg/m²）化疗，每天两次，持续4周，随后2周不进行化疗。经过四个疗程的全身S-1化疗后，EGD显示有一个小的、发红的病变，伴有聚集的白色线条。胃壁增厚和胃周区域淋巴结病也明显减轻。患者随后同意手术，接受了D2淋巴结清扫的全胃切除术。手术切除标本的大体检查显示有一个1.5×1.0cm的略呈红色的扁平病变。切除标本和采集的淋巴结的病理检查未发现恶性细胞。术后过程顺利。患者继续接受S-1化疗，术后4个月无复发迹象。据我们所知，这是英文文献中报道的第二例通过S-1单药治疗实现pCR的胃癌患者，表明S-1化疗后采用根治性切除作为晚期胃癌的治疗策略具有潜在可能性。
