Hirai Motoharu, Hanyu Takaaki, Ichikawa Hiroshi, Kano Yosuke, Muneoka Yusuke, Usui Kenji, Ishikawa Takashi, Ishikawa Hirosuke, Miura Kohei, Tajima Yosuke, Nakano Mae, Takizawa Kazuyasu, Shimada Yoshifumi, Sakata Jun, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1515-1517.
A 74-year-old man presented to our hospital with a mass in the left supraclavicular fossa. He was diagnosed with advanced gastric cancer with liver metastasis and left supraclavicular and para-aortic lymph node metastasis, cT3N2M1 (LYM, HEP), cStage Ⅳ(the Union for International Cancer Control, TNM 7th edition). He received a total of 3 courses of S- 1 plus cisplatin therapy. Since he developed adverse reactions such as anorexia, renal dysfunction, and thrombocytopenia and the tumor was HER2-positive, he received 25 courses of capecitabine, cisplatin, and trastuzumab chemotherapy. Three years and 2 months after the first chemotherapy, remarkable tumor reduction was observed. The patient then underwent radical distal gastrectomy with D2 lymphadenectomy, and R0 resection was achieved. The histopathological diagnosis was ypT1aN0M0, ypStage ⅠA. Chemotherapy with trastuzumab may improve the long-term prognosis of HER2-positive Stage Ⅳ gastric cancer if the disease is controlled and radical resection can be achieved.
一名74岁男性因左锁骨上窝肿物前来我院就诊。他被诊断为晚期胃癌伴肝转移及左锁骨上和主动脉旁淋巴结转移，cT3N2M1（LYM，HEP），c期Ⅳ（国际癌症控制联盟，TNM第7版）。他总共接受了3个疗程的S-1加顺铂治疗。由于出现了厌食、肾功能不全和血小板减少等不良反应，且肿瘤为HER2阳性，他接受了25个疗程的卡培他滨、顺铂和曲妥珠单抗化疗。首次化疗三年零两个月后，观察到肿瘤显著缩小。随后患者接受了D2淋巴结清扫的根治性远端胃切除术，实现了R0切除。组织病理学诊断为ypT1aN0M0，ypⅠA期。如果疾病得到控制并能实现根治性切除，曲妥珠单抗化疗可能会改善HER2阳性Ⅳ期胃癌的长期预后。
