A Multidisciplinary Approach for Advanced Gastric Cancer with Paraaortic Lymph Node Metastasis

作者：Fujiwara Yoshiyuki^*; Omori Takeshi; Demura Koichi; Miyata Hiroshi; Sugimura Keijiro; Ohue Masayuki; Kobayashi Shogo; Takahashi Hidenori; Doki Yuichiro; Yano Masahiko

来源：Anticancer Research, 2015, 35(12): 6739-6745.

• Gastric cancer
• para-aortic lymph node metastasis
• induction chemotherapy
• extended lymphadenectomy

Background: The prognosis for advanced gastric cancer with paraaortic lymph node (PALN) metastasis is very poor even after a curative resection. In the present study, induction chemotherapy followed by curative surgery was performed for advanced gastric cancer with PALN metastasis. Patients and Methods: Twenty patients with no non-curative factors except PALN metastasis who showed good clinical response for induction chemotherapy were enrolled in the study. Results: Combined S-1 plus cisplatin chemotherapy was administered to 10 patients; docetaxel, 5-FU plus cisplatin, to 5; S-1 plus paclitaxel to 3; and capecitabine plus cisplatin, to 2 patients. The overall response rate was 80% (16 out of 20 patients responded). All patients underwent curative gastrectomy with extended lymphadenectomy including the PALNs. Out of the 20 patients, 8 survived more than 5 years, and the 3- and 5-year survival rates were 72% and 65%, respectively. Female gender and residual PALN metastasis were significantly associated with worse prognosis and patients with a diffuse-type histology had a tendency to worse prognosis. Conclusion: Induction chemotherapy followed by curative surgery including extended PALN dissection seems a promising strategy for advanced gastric cancer with PALN metastasis as a sole distant metastasis, particularly for male patients and those with intestinal-type histology.

• 出版日期2015-12