Fukushima M
Department of Internal Medicine, Aichi Cancer Center, Chikusa-ku, Japan.
Semin Oncol. 1996 Jun;23(3):369-78.
The 5-year survival rate of patients with advanced gastric cancer who undergo curative resection is gradually increasing and currently ranges between 67.1% to 76.4% at the five major cancer centers in Japan. A belief that minimal residual disease has a high probability of being cured with adjuvant therapy prompted Japanese investigators to develop the D2 dissection with extended lymphadenectomy, more detailed pathologic staging, perioperative chemotherapy, and chemoimmunotherapy. This review focuses on comparative trials performed in Japan studying the use of adjuvant therapy with either chemotherapy alone or chemotherapy plus immunotherapy in the treatment of patients with curatively resected gastric carcinoma. Preoperative and intraperitoneal therapy also has been evaluated. At present, however, no chemotherapy has been shown to impact favorably on the survival of gastric cancer patients, whereas the biological response modifiers, PSK or OK-432, seem to add some benefit to chemotherapy in the adjuvant setting. Carefully designed randomized controlled trials with sufficient size which include a surgery-alone control arm are the only way to establish the efficacy of adjuvant therapy.
接受根治性切除的晚期胃癌患者的5年生存率正在逐步提高，目前在日本的五大癌症中心，这一比例在67.1%至76.4%之间。一种观点认为，微小残留病灶很有可能通过辅助治疗治愈，这促使日本研究人员开展了D2根治术，包括扩大淋巴结清扫、更详细的病理分期、围手术期化疗和化学免疫疗法。本综述聚焦于日本进行的比较试验，这些试验研究了单独使用化疗或化疗加免疫疗法的辅助治疗在治愈性切除的胃癌患者治疗中的应用。术前和腹腔内治疗也已得到评估。然而目前，尚无化疗被证明能对胃癌患者的生存产生有利影响，而生物反应调节剂PSK或OK-432，在辅助治疗中似乎能给化疗带来一些益处。精心设计的、规模足够大且包含单纯手术对照组的随机对照试验，是确立辅助治疗疗效的唯一途径。
