Yonemura Y, Kinoshita K, Fujimura T, Fushida S, Sawa T, Matsuki N, Tanaka S, Kamata T, Takashima T, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Hepatogastroenterology. 1996 Sep-Oct;43(11):1260-72.
BACKGROUND/AIMS: The surgical results for patients with stage IV gastric cancer are very poor. This study was performed to clarify the morphologic changes and survival after neoadjuvant chemotherapy for the stage IV gastric cancer patients.
Forty-three patients with stage advanced gastric cancer were treated with preoperative PMUE therapy by a combination use of cisplatin 75 mg/m2, mitomycin C 10 mg/body, etoposide 150 mg/body and UFT 400 mg/day. Among them, 32 patients underwent gastrectomy. Resected specimens were precisely examined histologically, and the histologic changes were correlated with clinical response and survival.
Histologic manifestations of neoadjuvant chemotherapy included coagulation necrosis of cancer cell, appearance of the giant cell with foamy degeneration, extracellular mucin pools, aggregates of foamy histiocytes and/or stromal fibrosis. Histological responses were obtained in 24 (75%) of 32 primary tumors, 13 (81%) of 16 liver metastases, 20 (76%) of 28 lymph node metastases and 3 (18%) of 17 peritoneal disseminations, respectively. Clinical responses were observed in 21 (49%), but there was no statistical survival difference between clinical responders and nonresponders. In contrast, histologic responders survived significantly longer than non-responders.
These results indicate that the grading of the histologic changes is a good prognosticator of patients treated with neoadjuvant chemotherapy, and yields an important information for the selection of postoperative chemotherapy.
背景/目的：IV期胃癌患者的手术结果非常差。本研究旨在阐明IV期胃癌患者新辅助化疗后的形态学变化及生存情况。
43例晚期胃癌患者接受术前PMUE治疗，联合使用顺铂75mg/m²、丝裂霉素C 10mg/体、依托泊苷150mg/体及优福定400mg/天。其中32例患者接受了胃切除术。对切除标本进行精确的组织学检查，并将组织学变化与临床反应及生存情况相关联。
新辅助化疗的组织学表现包括癌细胞的凝固性坏死、出现泡沫样变性的巨细胞、细胞外黏液池、泡沫样组织细胞聚集和/或间质纤维化。32例原发性肿瘤中有24例（75%）、16例肝转移中有13例（81%）、28例淋巴结转移中有20例（76%）、17例腹膜播散中有3例（18%）出现了组织学反应。临床反应见于21例（49%），但临床反应者与无反应者之间在生存方面无统计学差异。相比之下，组织学反应者的生存期明显长于无反应者。
这些结果表明，组织学变化的分级是新辅助化疗患者的良好预后指标，并为术后化疗的选择提供了重要信息。
