Hirao Takafumi, Yamamoto Kei, Oka Yoshio, Takada Naoya, Murao Shuhei, Higashiguchi Masaya, Takeda Takashi, Noguchi Kozo, Danno Katsuki, Toyoda Yasuhiro, Nakane Shigeru, Yamamoto Hitoshi
Dept. of Surgery, Minoh City Hospital.
Gan To Kagaku Ryoho. 2023 Dec;50(13):1560-1562.
We report the case of long-term survival of a patient with advanced antral gastric cancer with multiple paraaortic lymph nodes metastasis who was successfully treated with multidisciplinary therapy. A 70-year-old female was admitted to our hospital complaining of vomiting. Upper gastrointestinal endoscopy revealed a Type 3 tumor in the gastric antrum. Computed tomography(CT)showed a marked decrease in the size of the primary gastric tumor and lymph nodes after 9 courses of mFOLFOX6 therapy. Subsequently, 7 courses of paclitaxel plus ramucirumab(PTX plus Rmab)therapy and 10 courses of nivolumab therapy were administered. After nivolumab therapy, marked shrinkage of the lymph nodes was observed on CT. Distal gastrectomy with D2(+ #16a2+b1)lymph node dissection was performed. The pathological finding was ypT0N1M0 with a Grade 3 effect of the chemotherapy. After 6 months of adjuvant chemotherapy with S-1, CT revealed supraclavicular lymph node metastases. After 4 courses of nivolumab therapy, CT showed a marked increase in the size of the lymph node. Consequently, the regimen was changed to irinotecan. After 16 courses of irinotecan therapy, CT showed a marked shrinkage in the size of the lymph node. The patient is currently alive with no signs of recurrence for 5 years, ie, since the initiation of the multidisciplinary therapy.
我们报告了一例晚期胃窦癌伴多发腹主动脉旁淋巴结转移患者经多学科治疗后长期生存的病例。一名70岁女性因呕吐入院。上消化道内镜检查显示胃窦部有3型肿瘤。计算机断层扫描（CT）显示在接受9个疗程的mFOLFOX6治疗后，原发性胃肿瘤和淋巴结大小显著减小。随后，给予7个疗程的紫杉醇联合雷莫西尤单抗（PTX联合Rmab）治疗和10个疗程的纳武单抗治疗。纳武单抗治疗后，CT显示淋巴结明显缩小。行D2（+#16a2+b1）淋巴结清扫的远端胃切除术。病理结果为ypT0N1M0，化疗效果为3级。在接受S-1辅助化疗6个月后，CT显示锁骨上淋巴结转移。在接受4个疗程的纳武单抗治疗后，CT显示淋巴结大小明显增大。因此，治疗方案改为伊立替康。在接受16个疗程的伊立替康治疗后，CT显示淋巴结大小明显缩小。该患者自多学科治疗开始以来已存活5年，目前无复发迹象。
