Zhaoran Su, Min Kang, Kuanshan Shu, Kunfeng Li, Guihe Wang
Department of Gastrointestinal Surgery, people's hospital of Tongling City, Tongling, Anhui, People's Republic of China; Department of Digestive endoscopy, people's hospital of Tongling City, Tongling, Anhui, People's Republic of China.
Department of Pathology, people's hospital of Tongling City, Tongling, Anhui, People's Republic of China.
J Surg Res. 2022 Feb;270:162-168. doi: 10.1016/j.jss.2021.09.012. Epub 2021 Oct 19.
Conversion therapy is a promising option for unresectable locally advanced gastric cancer (GC) patients. This study aimed to investigate the feasibility and efficacy of conversion therapy based on S-1, apatinib combined with transarterial chemotherapy and embolization (TACE).
Twenty eligible unresectable locally advanced GC patients were enrolled in this single-arm, single-center, prospective clinical trial. Apatinib was administered orally at 0.5 g once daily and continuously for 58 d, while S-1 twice daily on d 1-14 was given at a dose calculated according to the body surface area and repeated every 3 wk for three cycles. TACE (oxaliplatin 80 mg/m and etoposide 80 mg/m) was performed on d 1 and was repeated on d 31.
Nineteen patients completed conversion therapy and no treatment-related deaths occurred. The objective response rate (ORR) was 94.7% (18/19) and noncurative factors had resolved in 13 patients (68.4%) based on imaging estimation. 18 patients received laparoscopic examination and 12 cases underwent definitive surgery. Based on the intraoperative and postoperative pathological examination, 10 patients received radical resection (R0 + D2/D2+). The patients who underwent the conversion surgery had a superior median overall survival (OS) compared with those who did not (P = 0.010).
S-1 combined with apatinib and TACE regimen is feasible for preoperative treating initial unresectable locally advanced GC patients with high rates of objective response and radical resection which may provide a survival benefit.
转化治疗是不可切除的局部晚期胃癌（GC）患者的一种有前景的选择。本研究旨在探讨基于S-1、阿帕替尼联合经动脉化疗栓塞术（TACE）的转化治疗的可行性和疗效。
20例符合条件的不可切除局部晚期GC患者纳入本单臂、单中心、前瞻性临床试验。阿帕替尼口服给药，剂量为0.5 g/d，持续58天，而S-1在第1 - 14天每天给药两次，剂量根据体表面积计算，每3周重复一次，共三个周期。TACE（奥沙利铂80 mg/m²和依托泊苷80 mg/m²）在第1天进行，并在第31天重复。
19例患者完成转化治疗，未发生与治疗相关的死亡。根据影像学评估，客观缓解率（ORR）为94.7%（18/19），13例患者（68.4%）的非治愈因素得到缓解。18例患者接受了腹腔镜检查，12例患者接受了根治性手术。根据术中及术后病理检查，10例患者接受了根治性切除（R0 + D2/D2+）。接受转化手术的患者的中位总生存期（OS）优于未接受转化手术的患者（P = 0.010）。
S-1联合阿帕替尼和TACE方案对术前治疗初始不可切除的局部晚期GC患者是可行的，具有较高的客观缓解率和根治性切除率，可能带来生存获益。
