Shimoyama S, Shimizu N, Kaminishi M
The Third Department of Surgery, University of Tokyo, 3-28-6, Mejirodai, Bunkyo-ku, Tokyo 112-8688, Japan.
World J Surg. 1999 Mar;23(3):284-91; discussion 291-2. doi: 10.1007/pl00013186.
Recent observations and our experience that histologic types of gastric cancer related significantly to patterns of recurrence prompted us to develop intraoperative and postoperative chemotherapy based on the preoperatively diagnosed histologic types of cancer and to evaluate its effectiveness by a prospective randomized trial. This chemotherapy regimen consisted of the intraoperative administration of mitomycin C (MMC) and postoperative administration of cisplatin (80 mg/patient, day 14), and tegaful and uracil (UFT) (300-600 mg/day for 2 years). Patients with a diffuse type of cancer were randomly assigned to one of three treatment groups: no intraoperative chemotherapy and UFT 300 mg/day (P0 group, n = 16); intraoperative chemotherapy and UFT 300 mg/day (P1 group, n = 13); or UFT 600 mg/day (P2 group, n = 17). Patients with an intestinal type of cancer were randomly assigned to one of three treatment groups: H0 (n = 17), H1 (n = 12), and H2 (n = 12); each group was subjected to the same protocols as the P0, P1, and P2 groups, respectively, except for the MMC administration route. MMC (10 mg/patient) was administered intraoperatively into the intraperitoneal cavity (P1 and P2 groups) or the portal vein (H1 and H2 groups). All patients underwent curative resection. Background factors did not differ significantly among the treatment groups. The overall survival rates were progressively worsened in the order of P2, P1, and P0 or H2, H1, and H0, respectively. The survival rate of the P2 group was statistically higher than that of the P0 group (p < 0.05). The intermediate-term survival rate of the P2 group or H2 group was significantly higher than that of the P0 group (p < 0.05) or H0 group (p < 0.05), respectively. These results suggest the effectiveness of this therapy and the possible eradication of potential micrometastatic foci outside the surgical field by the direct administration of chemotherapeutic agents to the predicted recurrence site.
近期的观察结果以及我们自身的经验表明，胃癌的组织学类型与复发模式显著相关，这促使我们基于术前诊断的癌症组织学类型制定术中及术后化疗方案，并通过前瞻性随机试验评估其疗效。该化疗方案包括术中给予丝裂霉素C（MMC），术后给予顺铂（80mg/患者，第14天）以及替加氟尿嘧啶（UFT）（300 - 600mg/天，持续2年）。弥漫型癌症患者被随机分为三个治疗组之一：无术中化疗且UFT 300mg/天（P0组，n = 16）；术中化疗且UFT 300mg/天（P1组，n = 13）；或UFT 600mg/天（P2组，n = 17）。肠型癌症患者被随机分为三个治疗组之一：H0（n = 17）、H1（n = 12）和H2（n = 12）；除MMC给药途径外，每组分别接受与P0、P1和P2组相同的方案。MMC（10mg/患者）术中经腹腔内给药（P1和P2组）或门静脉给药（H1和H2组）。所有患者均接受了根治性切除手术。各治疗组之间的背景因素无显著差异。总体生存率分别以P2、P1和P0组或H2、H1和H0组的顺序逐渐恶化。P2组的生存率在统计学上高于P0组（p < 0.05）。P2组或H2组的中期生存率分别显著高于P0组（p < 0.05）或H0组（p < 0.05）。这些结果表明了该疗法的有效性，以及通过将化疗药物直接给药至预测的复发部位可能根除手术野以外潜在的微小转移灶。
