Wakabayashi Yasuo, Okuno Atsushi, Togawa Akira
Dept. of Surgery, Toyo Municipal Hospital.
Gan To Kagaku Ryoho. 2020 Apr;47(4):621-624.
As a part of community screening, a 64-year-old man underwent gastric fluoroscopy, which revealed abnormalities indicative of a type 3 tumor. Contrast-enhanced abdominal computed tomography showed advanced gastric cancer with multiple regional lymph nodes and liver metastases. Chemotherapy was initiated, and after completion of 2 courses of capecitabine (Cape)and oxaliplatin(OHP)therapy, a distalgastrectomy was performed. The response to chemotherapy was Grade 2, and the lymph node status was pN1(1/17). The patient was strongly positive for HER2; thus, 4 courses of Cape, OHP, and trastuzumab(T-mab)therapy were administered for the metastatic liver lesions, and the liver metastases shrank markedly. S5 subsegmentectomy and S7 partial resection were performed subsequently, and pathological analysis showed completely necrotic tissue. Remarkable progress has been made in chemotherapy for gastric cancer, and the use of T-mab in combination is extremely effective for gastric cancer that is strongly positive for HER2. In our patient, we resected the primary lesion and liver metastatic lesions after neoadjuvant chemotherapy. The metastatic lesion showed complete response(CR). Metastases and recurrences can even occur in patients with primary and/or metastatic lesions who show a CR. Furthermore, whether cancers that are strongly positive for HER2 are recurrent remains unknown. The patient is alive and recurrence-free after having undergone a hepatectomy.
作为社区筛查的一部分，一名64岁男性接受了胃荧光镜检查，结果显示存在提示3型肿瘤的异常。腹部增强计算机断层扫描显示为进展期胃癌，伴有多个区域淋巴结和肝转移。开始进行化疗，在完成2个疗程的卡培他滨（Cape）和奥沙利铂（OHP）治疗后，进行了远端胃切除术。化疗反应为2级，淋巴结状态为pN1（1/17）。该患者HER2呈强阳性；因此，对肝转移灶给予了4个疗程的Cape、OHP和曲妥珠单抗（T-mab）治疗，肝转移灶明显缩小。随后进行了S5亚段切除术和S7部分切除术，病理分析显示为完全坏死组织。胃癌化疗已取得显著进展，联合使用T-mab对HER2强阳性的胃癌极为有效。在我们的患者中，新辅助化疗后切除了原发灶和肝转移灶。转移灶显示完全缓解（CR）。即使是原发灶和/或转移灶显示CR的患者也可能发生转移和复发。此外，HER2强阳性的癌症是否会复发仍不清楚。该患者接受肝切除术后存活且无复发。
