进展期胃癌伴腹主动脉旁淋巴结转移综合治疗的研究  

A comprehensive treatment for advanced gastric cancer with para-aortic lymph node metastasis

作　　者：魏晟宏[1] 王益[1] 叶再生[1] 郑钧尹 陈书[1] 曾奕[1] 林志涛 王志纬 陈小玲[1] 陈路川[1] Wei Shenghong;Wang Yi;Ye Zaisheng;Zheng Junyin;Chen Shu;Zeng Yi;Lin Zhitao;Wang Zhiwei;Chen Xiaoling;Chen Luchuan(Department of Gastrointestinal Surgery,Fujian Provincial Tumor Hospital,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院福建医科大学附属肿瘤医院胃肠外科,福州350014

出　　处：《中华普通外科杂志》2021年第4期244-248,共5页Chinese Journal of General Surgery

基　　金：福建医科大学启航基金(2017XQ1220);福建省医学创新课题(2019-CXB-9)。

摘　　要：目的探讨应用新辅助化疗联合手术治疗进展期胃癌患者伴腹主动脉旁淋巴结转移的安全性及预后。方法回顾性分析2015年1月至2017年6月福建省肿瘤医院胃肠外科收治的术前影像学提示腹主动脉旁淋巴结转移的25例胃癌患者的临床病理资料。所有患者术前均给予奥沙利铂联合替吉奥(SOX)方案化疗3个周期以后对达到腹主动脉旁淋巴结疾病稳定、部分缓解或完全缓解的患者进行D_(2)+腹主动脉旁淋巴结清扫术,术后用SOX方案进行5个周期的化疗。结果本组25例患者均完成SOX方案新辅助化疗3个周期,其中疾病进展2例,疾病稳定6例,部分缓解17例。23例患者接受手术治疗,19例患者获得R_(0)切除,总体R_(0)切除率为76%。全组共清扫腹主动脉旁淋巴结128个,其中转移淋巴结34个,淋巴结转移率44%,淋巴结转移度27%。5例(22%)患者出现术后并发症,无围手术期死亡。25例患者中位无进展生存时间和中位总生存时间分别为20、29个月。1、3年总生存率分别为80%、48%,1、3年无疾病进展生存率分别为72%、38%。10例腹主动脉旁淋巴结转移患者1年生存率为70%,3年生存率为17%。多因素分析表明,新辅助化疗疗效为独立预后因素。结论新辅助化疗是影响进展期胃癌伴腹主动脉旁淋巴结转移患者生存的独立预后因素。Objective To investigate the safety and prognostic value of neoadjuvant chemotherapy and surgery for advanced gastric cancer patients with para-aortic lymph node metastasis.Methods Clinicopathological data of 25 patients admitted to the Department of Gastrointestinal Surgery,Fujian Cancer Hospital from Jan 2015 to Jun 2017 were retrospectively analyzed.All patients were treated with SOX chemotherapy for 3 cycles.D_(2)+paraaortic lymphadenectomy was performed in patients with stable disease(SD).After operation,SOX regimen was used for 5 cycles of chemotherapy.Results After 3 cycles of neoadjuvant chemotherapy,there were 2 cases with progressive disease,6 cases of SD and 17 cases of partial remission.There was no treatment-related death.Twenty-three patients underwent surgery,including 19(76%)patients of R_(0) resection.Tirty-four out of 128 para aortic lymph nodes were metastatic.Postoperative complications occurred in 5(22%)patients,with no mortality.The median progression free survival time and median overall survival time were 20 and 29 months respectively.The 1,3-year overall survival rates were 80%and 48%,and the 1-year and 3-year progression free survival rates were 72%and 38%,respectively.For those with para-aortic lymph node metastasis the 1-year and 3-year OS rate were 70%and 17%,respectively.Multivariate analysis showed that the efficacy of neoadjuvant chemotherapy was an independent prognostic factor.Conclusion Neoadjuvant chemotherapy is among others an independent prognostic factor affecting the post-op survival of advanced gastric carcinoma with para-aortic lymph node metastasis.

关 键 词：胃肿瘤 淋巴转移 肿瘤辅助疗法 预后 

分 类 号：R735.2[医药卫生—肿瘤]