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新辅助化疗免疫治疗后转移性微卫星稳定型胃癌的完全缓解:我们仍应进行手术吗?一例病例报告及文献综述

Complete response of a metastatic microsatellite-stable gastric cancer after neoadjuvant chemoimmunotherapy: should we still operate? A case report and review of the literature.

作者信息

Mechahougui Hiba, Chevallay Mickael, Cauchy François, Chaveau Nicolas, Puppa Giacomo, Koessler Thibaud, Monig Stefan

机构信息

Department of Oncology, Geneva University Hospital, Geneva, Switzerland.

Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland.

出版信息

Front Oncol. 2024 Nov 20;14:1440046. doi: 10.3389/fonc.2024.1440046. eCollection 2024.

Abstract

Gastric cancer often presents at an advanced stage in Western populations due to a lack of screening programs, leading to poor prognoses. Historically, palliative chemotherapy resulted in a median survival of 9.9 months. However, the introduction of the FLOT regimen and immunotherapy has significantly altered treatment outcomes. Oligometastatic gastric cancer, defined as metastasis limited to a single organ or a few sites, has emerged as a distinct subgroup with improved survival when treated with a combination of systemic and local therapies. We present the case of a 54-year-old male patient diagnosed with microsatellite-stable (MSS) oligometastatic gastric adenocarcinoma, including liver and peritoneal metastases, who achieved a complete pathological response following neoadjuvant chemoimmunotherapy with FOLFOX and nivolumab. Despite unfavorable prognostic factors, such as liver involvement and positive peritoneal cytology, the patient responded well to the treatment, allowing curative surgery. Postoperative histology confirmed complete regression of both the primary tumor and metastases, with no recurrence observed at the 1-year follow-up. This case shows the potential of combined chemoimmunotherapy to convert previously inoperable MSS gastric cancer to surgical candidates. Further research is needed to better define patient selection criteria and assess long-term outcomes for these patients.

摘要

在西方人群中,由于缺乏筛查项目,胃癌往往在晚期才被发现,导致预后不良。从历史上看,姑息化疗的中位生存期为9.9个月。然而,FLOT方案和免疫疗法的引入显著改变了治疗结果。寡转移性胃癌被定义为转移局限于单个器官或少数部位,已成为一个独特的亚组,采用全身和局部治疗相结合的方法治疗时生存率有所提高。我们报告一例54岁男性患者,诊断为微卫星稳定(MSS)寡转移性胃腺癌,包括肝转移和腹膜转移,在接受FOLFOX和纳武单抗新辅助化疗免疫治疗后实现了完全病理缓解。尽管存在不利的预后因素,如肝转移和腹膜细胞学阳性,但患者对治疗反应良好,得以进行根治性手术。术后组织学证实原发性肿瘤和转移灶均完全消退,在1年随访中未观察到复发。该病例显示了联合化疗免疫疗法将先前无法手术的MSS胃癌转化为手术候选者的潜力。需要进一步研究以更好地确定患者选择标准并评估这些患者的长期预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bf/11614720/696a709b4943/fonc-14-1440046-g001.jpg

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