Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
In Vivo. 2021 Jul-Aug;35(4):2247-2251. doi: 10.21873/invivo.12497.
Multimodality treatment including immune check point inhibitors is required for stage IV oesophagogastric junction cancer (OGJC).
A 69-year-old man, was diagnosed with advanced OGJC and para-aortic lymph node metastasis (T3N+M1, stage IV), which upon biopsy, was shown to be an adenocarcinoma. After eight courses of nivolumab as third-line chemotherapy, the primary tumour and enlarged regional and para-aortic lymph nodes shrunk markedly, while tumour markers decreased within normal ranges. We performed a minimally invasive Ivor-Lewis oesophagectomy with completion of an abdominal D2 and transhiatal lower mediastinal lymph node dissection. Pathological findings revealed a complete response for the primary tumour and a regional lymph node metastasis. A biopsy of the previous sample revealed microsatellite instability-negativity, Epstein-Barr virus-negativity, and programmed cell death-1-ligand combined positive score of 2. He was followed up for 3 months without recurrence.
Nivolumab may induce pathological complete response for stage IV OGJC even in cases negative for microsatellite instability and Epstein-Barr virus, besides the programmed cell death-1-ligand combined positive score of <5.
包括免疫检查点抑制剂在内的多模态治疗需要用于 IV 期食管胃结合部癌（OGJC）。
一名 69 岁男性，被诊断为晚期 OGJC 和腹主动脉旁淋巴结转移（T3N+M1，IV 期），活检显示为腺癌。在接受纳武利尤单抗作为三线化疗的 8 个疗程后，原发肿瘤和扩大的区域及腹主动脉旁淋巴结明显缩小，而肿瘤标志物在正常范围内下降。我们进行了微创的 Ivor-Lewis 食管切除术，并完成了腹部 D2 和经食管裂孔下纵隔淋巴结清扫术。病理检查显示原发肿瘤和区域淋巴结转移完全缓解。对先前样本的活检显示微卫星不稳定性阴性、EB 病毒阴性、程序性死亡配体 1 联合阳性评分 2。他在 3 个月内没有复发。
纳武利尤单抗可能诱导 IV 期 OGJC 发生病理完全缓解，即使在微卫星不稳定性和 EB 病毒阴性的情况下，以及程序性死亡配体 1 联合阳性评分<5 的情况下也是如此。
