Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Gastric Cancer. 2020 Mar;23(2):293-299. doi: 10.1007/s10120-019-01007-w. Epub 2019 Sep 12.
Preoperative chemotherapy with cisplatin plus S-1 (CS) followed by gastrectomy with D2 plus para-aortic lymph node (PAN) dissection is regarded as a standard treatment in Japan for advanced gastric cancer with bulky lymph node (BN) and/or PAN metastasis. In the JCOG1002, we added docetaxel to CS (DCS) to further improve long-term outcomes. However, the primary endpoint, clinical response rate (RR), did not reach the expected level (Ito et al. in Gastric Cancer 20:322-31, 2017). Herein, we report our long-term survival results.
Patients with BN and/or PAN metastasis received 2 or 3 cycles of DCS therapy (docetaxel at 40 mg/m and cisplatin at 60 mg/m on day 1 and S-1 at 80 mg/m per day for 2 weeks, followed by a 2-week rest) followed by gastrectomy with D2 plus PAN dissection and postoperative S-1 for 1 year.
Between July 2011 and May 2013, 53 patients were enrolled. Clinically, 17.0% had both PAN and BN metastasis, and the rest had either PAN (26.4%) or BN (56.6%) metastasis. Among all eligible patients, the 5-year overall survival was 54.9% (95% confidence interval 40.3-67.3%) at the last follow-up in May 2018. Among 44 eligible patients with R0 resection, the 5-year relapse-free survival was 47.7% (95% confidence interval 32.5-61.5%).
Adding docetaxel to CS in preoperative chemotherapy for extensive nodal metastasis improved neither short-term outcomes nor long-term survival. Preoperative chemotherapy with CS followed by D2 + PAN dissection and postoperative S-1 remains the standard of care for patients with extensive nodal metastasis.
顺铂联合 S-1（CS）术前化疗后行 D2 加腹主动脉旁淋巴结（PAN）清扫术被认为是日本治疗伴有大淋巴结（BN）和/或 PAN 转移的晚期胃癌的标准治疗方法。在 JCOG1002 中，我们在 CS 中加入多西他赛（DCS）以进一步提高长期疗效。然而，主要终点，临床缓解率（RR），并未达到预期水平（Ito 等人，Gastric Cancer 20：322-31，2017）。在此，我们报告了我们的长期生存结果。
伴有 BN 和/或 PAN 转移的患者接受 2 或 3 周期的 DCS 治疗（多西他赛 40mg/m 和顺铂 60mg/m 于第 1 天，S-1 80mg/m 每日 2 周，随后休息 2 周），随后行 D2 加 PAN 清扫术和术后 S-1 治疗 1 年。
2011 年 7 月至 2013 年 5 月期间，共纳入 53 例患者。临床检查发现，17.0%的患者同时存在 PAN 和 BN 转移，其余患者仅存在 PAN（26.4%）或 BN（56.6%）转移。所有符合条件的患者中，截止 2018 年 5 月最后一次随访时，5 年总生存率为 54.9%（95%置信区间 40.3-67.3%）。在 44 例 R0 切除的合格患者中，5 年无复发生存率为 47.7%（95%置信区间 32.5-61.5%）。
CS 术前化疗中加入多西他赛并未改善广泛淋巴结转移患者的短期疗效或长期生存。CS 术前化疗后行 D2+PAN 清扫术和术后 S-1 治疗仍然是广泛淋巴结转移患者的标准治疗方法。
