Ami Katsunori, Yamashita Daisuke, Yamada Azusa, Kajiyama Daisuke, Kawaguchi Machiko, Maeda Fumi, Motoyama Kazuo, Amagasa Hidetoshi, Ganno Hideaki, Imai Kenichirou, Iida Satoru, Fukuda Akira, Akita Hidetaka, Tei Shikofumi, Andou Masayuki
Dept. of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Toshima Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2467-2469.
Currently, chemotherapy against unresectable advanced gastric cancer is progressing with the development new drugs and due to results of several clinical trials. Here, we reported a case of long-term survival of gastric cancer with multiple liver and lymph node metastases. A 68-year-old man was diagnosed with gastric cancer and Virchow lymph node, para-aortic lymph node, and multiple liver metastases at another hospital. He was referred to our hospital from Yamashita Naika Syokakika. We administrated 4 courses of S-1 plus CDDP. The main tumor and all metastatic lesions were significantly reduced. Subsequently, total gastrectomy, partial liver resection, and left neck and para-aortic lymph node resection(conversion surgery)were performed. The cancer cell was remnant at the main tumor and para-gastric lymph node. No cancer cells were detected in another lesion(R0 resection). Postoperatively, only S-1 was administered. However, 28 months after undergoing gastrectomy, liver metastasis occurred. Therefore, S-1 plus oxaliplatin, paclitaxel plus ramucirumab, and CPT-11 plus CDDP were administered. Liver metastases again increased and decreased, respectively. However, 46 months after gastrectomy, liver metastasis recurred and nivolumab was administered. Subsequently, liver metastases disappeared. At 55 months after gastrectomy, rectal resection was performed against rectal cancer and partial liver resection against liver metastases. Cancer cells were not detected in the resected specimens.
目前，随着新药的研发以及多项临床试验结果的出现，针对不可切除的晚期胃癌的化疗正在取得进展。在此，我们报告了一例伴有多发肝转移和淋巴结转移的胃癌患者长期生存的病例。一名68岁男性在另一家医院被诊断为胃癌伴魏尔啸淋巴结、主动脉旁淋巴结及多发肝转移。他从山下内科医院转诊至我院。我们给予了4个疗程的S-1加顺铂治疗。主要肿瘤及所有转移病灶均显著缩小。随后，进行了全胃切除术、部分肝切除术以及左颈部和主动脉旁淋巴结切除术（转换手术）。在主要肿瘤和胃旁淋巴结处残留癌细胞。在其他病灶未检测到癌细胞（R0切除）。术后仅给予S-1治疗。然而，在接受胃切除术后28个月，发生了肝转移。因此，给予了S-1加奥沙利铂、紫杉醇加雷莫西尤单抗以及伊立替康加顺铂治疗。肝转移灶分别再次增大和缩小。然而，在胃切除术后46个月，肝转移复发，给予了纳武单抗治疗。随后，肝转移灶消失。在胃切除术后55个月，针对直肠癌进行了直肠切除术，针对肝转移进行了部分肝切除术。在切除标本中未检测到癌细胞。
