Noumi Taku, Ishizaki Masahiro, Tanioka Hiroaki, Yoshikawa Chihiro, Kawasaki Kento, Mushiaki Yasushi, Iga Norichika, Yoshida Ryosuke, Waki Naohisa, Kawai Hiroshi, Uno Futoshi, Nishi Hideyuki, Yamashita Kazuki, Sonobe Hiroshi
Dept. of Internal Medicine, Okayama Rosai Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2072-2074.
This case was observed in a man in his 70s. Although symptomatic treatment was performed for epigastralgia, endoscopic examination revealed a type 3 tumor on the fornix of the stomach to the lesser curvature of the body just above the esophagogastric junction, and the patient was diagnosed with moderately differentiated tubular adenocarcinoma(cT4bN3aM0, cStage ⅣA). As esophageal and diaphragmatic invasion was suspected based on CT findings, S-1 plus CDDP was started as preoperative chemotherapy. Although the primary lesion and lymph node metastasis decreased in size, chemotherapy was discontinued after one course due to stenosis symptoms, and total gastrectomy and D2 dissection were performed. Postoperative adjuvant chemotherapy with S-1 was started. However, 6 months after starting the treatment, para-aortic lymph node recurrence was observed, and the treatment strategy was changed to weekly PTX. After 5 courses of weekly PTX, the lymph nodes continued to increase in size, and chemotherapy was discontinued per the patient's request. The patient was followed up with CT and PET-CT; however, no new recurrent lesions were found in other sites for approximately 1 year. Therefore, para-aortic lymph node dissection was performed as the salvage surgery. Pathological findings showed that gastric cancer metastasis was present in 1 swollen lymph node only, as confirmed by PET. At present, 6 years have passed since the first operation, and there has been no recurrence. In general, para-aortic lymph node metastasis is considered to result in poor prognosis in gastric cancer. However, in the absence of other noncurative factors, a good prognosis may be obtained with combined therapeutic modalities.
该病例为一名70多岁男性。尽管针对上腹部疼痛进行了对症治疗，但内镜检查发现胃穹窿至食管胃交界处上方胃体小弯处有3型肿瘤，患者被诊断为中分化管状腺癌（cT4bN3aM0，c期ⅣA）。基于CT检查结果怀疑有食管和膈肌侵犯，遂开始使用S-1加顺铂进行术前化疗。尽管原发灶和淋巴结转移灶大小减小，但由于出现狭窄症状，化疗一个疗程后停药，随后进行了全胃切除术和D2淋巴结清扫术。术后开始使用S-1进行辅助化疗。然而，治疗开始6个月后，发现主动脉旁淋巴结复发，治疗策略改为每周使用紫杉醇（PTX）。每周使用PTX 5个疗程后，淋巴结持续增大，应患者要求停止化疗。对患者进行CT和PET-CT随访；然而，大约1年内在其他部位未发现新的复发灶。因此，作为挽救性手术进行了主动脉旁淋巴结清扫术。病理结果显示，仅1个肿大淋巴结存在胃癌转移，PET检查已证实。目前，自首次手术以来已过去6年，未出现复发。一般来说，主动脉旁淋巴结转移被认为会导致胃癌预后不良。然而，在不存在其他非治愈性因素的情况下，联合治疗方式可能会获得良好的预后。
