集学的治療により根治手術を施行しえた,HER2原発陰性/腹膜播種陽性のStage IV胃癌の1例

症例は77歳の男性で,胃癌cT4a(SE)N0P1H0M0,cStage IV,HER2陰性と診断しS-1+CDDP療法を開始した.1コース目day 19に胃穿孔による汎発性腹膜炎を来し緊急手術を施行し胃体部前壁の腫瘍潰瘍底に穿孔を認め穿孔部縫合閉鎖,大網被覆術を施行した.腹膜播種がHER2陽性であったためcapecitabine(X)+CDDP+trastuzumab(H)療法に変更し,計11コース後の診断的腹腔鏡でP0CY0と診断した.胃全摘術,脾温存D2郭清術(R0)を施行し最終診断はypT3N0(0/45)yP0H0M0,ypStage IIAで組織学的効果判定はGrade 1bであっ...

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Published in日本消化器外科学会雑誌 Vol. 49; no. 9; pp. 867 - 872
Main Authors 長, 晴彦, 佐藤, 勉, 利野, 靖, 前澤, 幸男, 青山, 徹, 吉川, 貴己, 中島, 哲史, 尾形, 高士, 瀬上, 顕貴, 神尾, 一樹
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 2016
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2015.0195

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Abstract 症例は77歳の男性で,胃癌cT4a(SE)N0P1H0M0,cStage IV,HER2陰性と診断しS-1+CDDP療法を開始した.1コース目day 19に胃穿孔による汎発性腹膜炎を来し緊急手術を施行し胃体部前壁の腫瘍潰瘍底に穿孔を認め穿孔部縫合閉鎖,大網被覆術を施行した.腹膜播種がHER2陽性であったためcapecitabine(X)+CDDP+trastuzumab(H)療法に変更し,計11コース後の診断的腹腔鏡でP0CY0と診断した.胃全摘術,脾温存D2郭清術(R0)を施行し最終診断はypT3N0(0/45)yP0H0M0,ypStage IIAで組織学的効果判定はGrade 1bであった.術後X+H療法を再開し胃全摘後7か月経過したが無再発生存中である.原発巣のHER2が陰性であっても転移巣のHER2が陽性であればtrastuzumabを用いた化学療法が奏効する可能性が示唆された.
AbstractList 症例は77歳の男性で,胃癌cT4a(SE)N0P1H0M0,cStage IV,HER2陰性と診断しS-1+CDDP療法を開始した.1コース目day 19に胃穿孔による汎発性腹膜炎を来し緊急手術を施行し胃体部前壁の腫瘍潰瘍底に穿孔を認め穿孔部縫合閉鎖,大網被覆術を施行した.腹膜播種がHER2陽性であったためcapecitabine(X)+CDDP+trastuzumab(H)療法に変更し,計11コース後の診断的腹腔鏡でP0CY0と診断した.胃全摘術,脾温存D2郭清術(R0)を施行し最終診断はypT3N0(0/45)yP0H0M0,ypStage IIAで組織学的効果判定はGrade 1bであった.術後X+H療法を再開し胃全摘後7か月経過したが無再発生存中である.原発巣のHER2が陰性であっても転移巣のHER2が陽性であればtrastuzumabを用いた化学療法が奏効する可能性が示唆された.
Author 尾形, 高士
青山, 徹
長, 晴彦
佐藤, 勉
神尾, 一樹
瀬上, 顕貴
前澤, 幸男
中島, 哲史
利野, 靖
吉川, 貴己
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References 9) Gumusay O, Benekli M, Ekinci O, Baykara M, Ozet A, Coskun U, et al. Discordances in HER2 status between primary gastric cancer and corresponding metastatic sites. Jpn J Clin Oncol. 2015;45(5):416–421.
4) Yang HK, Tsujinaka T, Nakamura K, Kim YW, Terashima M, Han SU, et al. Randomized controlled trial of comparing gastrectomy (Gx) plus chemotherapy (CTX) with CTX alone in advanced gastric cancer (AGC) with a single non-curable factor: JCOG 0705/KGCA01 study (REGATTA). 2015 ASCO Annual Meeting. J Clin Oncol. 2015;33(suppl):abstr 200.
8) Pagni F, Zannella S, Ronchi S, Garanzini C, Leone BE. HER2 status of gastric carcinoma and corresponding lymph node metastasis. Pathol Oncol Res. 2013;19(1):103–109.
10) Peng Z, Zou J, Zhang X, Yang Y, Gao J, Li Y, et al. HER2 discordance between paired primary gastric cancer and metastasis: a meta-analysis. Chin J Cancer Res. 2015;27(2):163–171.
1) Asmis TR, Capanu M, Kelsen DP, Shah MA. Systemic chemotherapy does not increase the risk of gastrointestinal perforation. Ann Oncol. 2007;18(12):2006–2008.
3) Roviello F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani C, Morgagni P, et al. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol. 2006;4:19.
6) Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–697.
7) Bozzetti C, Negri FV, Lagrasta CA, Crafa P, Bassano C, Tamagnini I, et al. Comparison of HER2 status in primary and paired metastatic sites of gastric carcinoma. Br J Cancer. 2011;104(9):1372–1376.
5) Hata T, Sakata N, Kudoh K, Shibata C, Unno M. The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy. Gastric Cancer. 2014;17(3):578–587.
2) Kang MH, Kim SN, Kim NK, Park YI, Kim YW, Ryu KW, et al. Clinical outcomes and prognostic factors of metastatic gastric carcinoma patients who experience gastrointestinal perforation during palliative chemotherapy. Ann Surg Oncol. 2010;17(12):3163–3172.
References_xml – reference: 6) Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–697.
– reference: 4) Yang HK, Tsujinaka T, Nakamura K, Kim YW, Terashima M, Han SU, et al. Randomized controlled trial of comparing gastrectomy (Gx) plus chemotherapy (CTX) with CTX alone in advanced gastric cancer (AGC) with a single non-curable factor: JCOG 0705/KGCA01 study (REGATTA). 2015 ASCO Annual Meeting. J Clin Oncol. 2015;33(suppl):abstr 200.
– reference: 9) Gumusay O, Benekli M, Ekinci O, Baykara M, Ozet A, Coskun U, et al. Discordances in HER2 status between primary gastric cancer and corresponding metastatic sites. Jpn J Clin Oncol. 2015;45(5):416–421.
– reference: 5) Hata T, Sakata N, Kudoh K, Shibata C, Unno M. The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy. Gastric Cancer. 2014;17(3):578–587.
– reference: 8) Pagni F, Zannella S, Ronchi S, Garanzini C, Leone BE. HER2 status of gastric carcinoma and corresponding lymph node metastasis. Pathol Oncol Res. 2013;19(1):103–109.
– reference: 10) Peng Z, Zou J, Zhang X, Yang Y, Gao J, Li Y, et al. HER2 discordance between paired primary gastric cancer and metastasis: a meta-analysis. Chin J Cancer Res. 2015;27(2):163–171.
– reference: 2) Kang MH, Kim SN, Kim NK, Park YI, Kim YW, Ryu KW, et al. Clinical outcomes and prognostic factors of metastatic gastric carcinoma patients who experience gastrointestinal perforation during palliative chemotherapy. Ann Surg Oncol. 2010;17(12):3163–3172.
– reference: 1) Asmis TR, Capanu M, Kelsen DP, Shah MA. Systemic chemotherapy does not increase the risk of gastrointestinal perforation. Ann Oncol. 2007;18(12):2006–2008.
– reference: 3) Roviello F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani C, Morgagni P, et al. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol. 2006;4:19.
– reference: 7) Bozzetti C, Negri FV, Lagrasta CA, Crafa P, Bassano C, Tamagnini I, et al. Comparison of HER2 status in primary and paired metastatic sites of gastric carcinoma. Br J Cancer. 2011;104(9):1372–1376.
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Snippet 症例は77歳の男性で,胃癌cT4a(SE)N0P1H0M0,cStage IV,HER2陰性と診断しS-1+CDDP療法を開始した.1コース目day 19に胃穿孔による汎発性腹膜炎を来し緊急手術を施行し...
SourceID jstage
SourceType Publisher
StartPage 867
SubjectTerms HER2過剰発現/増幅の不一致
HER2陽性胃癌
胃穿孔
Title 集学的治療により根治手術を施行しえた,HER2原発陰性/腹膜播種陽性のStage IV胃癌の1例
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