进展期胃癌新辅助化疗原发灶病理完全缓解5例报告及文献复习

Pathological complete response of locally advanced gastric cancer after neoadjuvant chemotherapy: a report of five cases and a literature review

进展期胃癌不可切除率及术后复发率较高,新辅助化疗联合手术切除是最常见的胃癌多学科综合治疗方法之一,具有以下优点:使肿瘤降期,提高R0切除率;对于高强度化疗的耐受性较辅助化疗好,化疗完成率较辅助化疗高;提供活体药敏检测从而避免不必要的手术。虽然高强度化疗产生更高的客观反应率,但是进展期胃癌经新辅助化疗获得病理完全缓解的仍然较少,且缺乏相关诊治规范。现介绍在广西医科大学附属肿瘤医院胃肠外科予新辅助化疗后获得病理完全缓解的5例进展期胃癌,以探讨该类患者的临床病理特征、合理的综合治疗决策及预后的相关因素,使临床诊疗更加规范,患者更多获益。

Advanced gastric cancer without distant metastasis remains a potentially curable disease, but the prognosis is poor in this condition because of the high unresectability rate at presentation and the high recurrence rate after radical surgery. Administration of neoadjuvant chemotherapy has several potential benefits for advanced gastric cancer. This treatment can decrease tumor stage and improve R0 resection rate. Neoadjuvant chemotherapy has higher patient tolerability and a higher rate of chemotherapy completion than adjuvant chemotherapy. In vivo drug sensitivity tests can also be conducted to avoid unnecessary surgeries. Although high-intensity chemotherapy results in a high overall response rate, a few advanced gastric patients can achieve a pathologically complete response. However, no standardized treatment has been achieved. This article introduces five cases of advanced gastric cancer treated with neoadjuvant chemotherapy in the Affiliated Tumor Hospital of Guangxi Medical University. The five cases achieved a pathological complete response. This article also aims to explore the clinicopathological characteristics of these patients, proper cooperative treatment practices, and prognostic factors for the benefit of future patients.