Fukuda Kosuke, Arigami Takaaki, Tokuda Koki, Yanagita Shigehiro, Matsushita Daisuke, Kawasaki Yota, Iino Satoshi, Sasaki Ken, Nakajo Akihiro, Kirishima Mari, Tanimoto Akihide, Tsubouchi Hitoshi, Kurahara Hiroshi, Ohtsuka Takao
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Onco-Biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Surg Case Rep. 2022 Apr 1;8(1):58. doi: 10.1186/s40792-022-01412-x.
In recent years, conversion surgery after chemotherapy has been considered a promising strategy for improving the prognosis of patients with stage IV gastric cancer. However, there are few reports on conversion gastrectomy after second-line chemotherapy. Here, we report a case of long-term survival of a patient with liver metastases from gastric cancer who underwent conversion surgery after second-line chemotherapy with ramucirumab and paclitaxel.
A 77-year-old man complaining of weight loss was diagnosed with human epidermal growth factor receptor 2-positive gastric cancer with multiple liver metastases. Although the patient initially received trastuzumab-based chemotherapy, it was discontinued, because he experienced trastuzumab-induced infusion reactions. Thereafter, he was treated with six courses of S-1 plus cisplatin and six courses of ramucirumab plus paclitaxel as the first- and second-line regimens, respectively. The primary tumor and liver metastases remarkably shrank, and the reduction rate of the measurable metastatic liver lesions was 81.1%. According to the Response Evaluation Criteria in Solid Tumors, the patient responded partially. Therefore, he underwent total gastrectomy with D2 lymphadenectomy and partial hepatectomy of segments 3 and 4. Pathological examination revealed tumor invasion into the muscularis propria, a grade 1a histological response, and no lymph node metastases. No viable cancer cells were identified in the specimens resected from liver segments 3 and 4. Accordingly, the patient was pathologically diagnosed with stage IB (ypT2N0M0). Postoperatively, the patient received adjuvant chemotherapy with S-1 for 6 months, and he survived without recurrence for 42 months after conversion surgery.
Conversion surgery might be clinically useful for improving survival in certain patients with gastric cancer, including those who previously received second-line chemotherapy.
近年来，化疗后进行转化手术被认为是改善IV期胃癌患者预后的一种有前景的策略。然而，关于二线化疗后进行转化性胃切除术的报道较少。在此，我们报告一例胃癌肝转移患者在接受雷莫西尤单抗和紫杉醇二线化疗后进行转化手术并长期生存的病例。
一名77岁男性，因体重减轻就诊，被诊断为人表皮生长因子受体2阳性胃癌伴多发肝转移。尽管患者最初接受了以曲妥珠单抗为基础的化疗，但因出现曲妥珠单抗诱导的输注反应而停药。此后，他分别接受了六个疗程的S-1加顺铂和六个疗程的雷莫西尤单抗加紫杉醇作为一线和二线治疗方案。原发肿瘤和肝转移灶明显缩小，可测量的肝转移灶缩小率为81.1%。根据实体瘤疗效评价标准，患者部分缓解。因此，他接受了D2淋巴结清扫的全胃切除术和3、4段部分肝切除术。病理检查显示肿瘤侵犯固有肌层，组织学反应为1a级，无淋巴结转移。在3、4段肝脏切除标本中未发现存活癌细胞。因此，患者病理诊断为IB期（ypT2N0M0）。术后，患者接受了6个月的S-1辅助化疗，转化手术后存活42个月无复发。
转化手术可能对改善某些胃癌患者的生存具有临床意义，包括那些先前接受过二线化疗的患者。
