Nishiyama Masaki, Miki Yuichiro, Tanaka Hiroaki, Yoshii Mami, Kuroda Kenji, Kasashima Hiroaki, Fukuoka Tatsunari, Tamura Tatsuro, Shibutani Masatsune, Toyokawa Takahiro, Lee Shigeru, Maeda Kiyoshi
Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
J Surg Res. 2025 Feb;306:533-542. doi: 10.1016/j.jss.2024.12.053. Epub 2025 Jan 30.
In order to clarify the optimal strategy regarding conversion surgery (CS) for gastric cancer (GC) patients, we focused on clinicopathological findings, including immunological factors, related to the favorable prognosis in patients with stage IV GC who underwent CS.
A total of 25 patients with Stage IV GC who underwent induction chemotherapy (IC) and CS at our hospital between 2010 and 2021 were enrolled in this study. Biopsy specimens before IC and surgical specimens were collected. Immunohistochemical staining was performed using programmed death-ligand 1 (PD-L1) antibody, translationally controlled tumor protein (TCTP) antibody, and CD20 antibody. Prognostic factors were investigated using clinicopathological factors as well as immunological factors such as PD-L1, TCTP, and CD20 expression.
cN0, ycStage1-2, R0-1 surgery, D2 lymph node dissection, ypN0, and ypStage1-2 were significantly associated with favorable overall survival. Among patients who underwent R0/1 surgery, only histological type was a significant prognostic factor for recurrence-free survival. Low PD-L1 expression before IC and high TCTP expression after IC were significantly associated with favorable recurrence-free survival.
In addition to clinical factors, high TCTP expression after IC was identified as a significant favorable prognostic factor, which could help in identifying candidates for CS in the future.
为了阐明胃癌（GC）患者转化手术（CS）的最佳策略，我们重点关注了与接受CS的IV期GC患者良好预后相关的临床病理特征，包括免疫因素。
本研究纳入了2010年至2021年间在我院接受诱导化疗（IC）和CS的25例IV期GC患者。收集IC前的活检标本和手术标本。使用程序性死亡配体1（PD-L1）抗体、翻译调控肿瘤蛋白（TCTP）抗体和CD20抗体进行免疫组织化学染色。使用临床病理因素以及诸如PD-L1、TCTP和CD20表达等免疫因素研究预后因素。
cN0、ycStage1-2、R0-1手术、D2淋巴结清扫、ypN0和ypStage1-2与良好的总生存期显著相关。在接受R0/1手术的患者中，仅组织学类型是无复发生存期的显著预后因素。IC前低PD-L1表达和IC后高TCTP表达与良好的无复发生存期显著相关。
除临床因素外，IC后高TCTP表达被确定为显著的良好预后因素，这可能有助于未来识别CS的候选者。
