摘要
胃癌的转化治疗针对初始部分不可切除，但有潜在手术切除机会的胃癌患者，在接受全身系统化疗后，其不可切除因素出现部分或完全缓解，可行R0切除。从而获得相对较长的术后生存时间和（或）元复发生存时间。既往初始不可切除胃癌转化治疗研究提示，较好的化疗反应率和病理反应率、转化治疗后获得R0切除是初始不可切除胃癌患者接受转化治疗的独立预后因素，起始非治愈因素为淋巴结转移者的疗效优于腹膜种植者。转化治疗的化疗方案一直在尝试改进,报道的效果也存在差异,但最新的临床研究多提示，以紫杉醇为基础的三药化疗可使初始不可切除胃癌患者获得较高缓解率和R0切除机会，从而延长生存期。然而。由于初始不可切除胃癌的生物学行为特点高度异质性，并非均能从转化治疗中获益。对数量如此庞大的初始不可切除胃癌患者，筛选出适合转化的病例进行转化治疗、不适合转化治疗则侧重于改善生活质量，将是胃癌治疗领域的热点。但是，目前初始不可切除胃癌转化治疗尚处于初期探索阶段，相关研究主要为一些单中心、小样本的报道，异质性较大，故其可行性、安全性和有效性的循证医学证据不足。目前转化治疗指征、病例选择、方案制定、疗效评价、手术时机、手术切除范围等方面尚无共识，亟需更多高水平的临床研究证据进行验证和指导。所以，胃癌转化治疗需要各方共同努力，通过临床试验不断摸索，完善其诊治标准。并逐步探索和筛选出精细分类基础上的转化治疗最佳获益人群，为临床治疗提供可靠的指导。因此，本文对初始不可切除胃癌的转化治疗研究进展作一综述。
Conversion therapy is adopted to achieve radical cure for patients with originally unresectable but potentially resectable late stage gastric cancer, who obtain partial or complete remission after systemic chemotherapy, to acquire relatively longer postoperative survival and recurrence-free survival. Some of the previous researches on conversion therapy for originally unresectable gastric cancer suggest that high chemotherapy response rate, high pathological response rate and R0 resection rate are associated with favorable prognosis. And the efficacy of patients with lymphatic metastasis is better than that of those with peritoneal metastasis. The protocol of conversional chemotherapy varies and so does its efficacy according to different reports. Latest clinical researches indicate that initially unresectable gastric cancer gained higher remission rate and better chance of R0 operation and consequently prolonged survival from paclitaxel based triplet chemotherapy. However, not all originally unresectable gastric cancer can benefit from conversion therapy due to the high heterogeneity of its biological behavior. Regarding the enormous number of originally unresectable gastric cancer patients, it will be a research hot spot in the field of surgical oncology, on screening criteria to select cases suitable for conversion. Exploration on conversion therapy for gastric cancer is still at initial stage, and reports that have been published are mostly single-centered with limited sample, lacking of sufficient evidence on its feasibility, safety and efficacy. Expert consensus on conversion indication, case selection, chemotherapy regimen, efficacy assessment and resection range is absent. So it is in urgent need for higher level clinical evidence to support and guide this practice. Such goal can never be achieved without joint efforts of all parties to carry out clinical trial to modify the practice of conversion therapy for late stage gastric cancer, and determine the proper selection of suitable candidates for conversi
作者
陈新华
林周盛
陈粤泓
罗俊
朱煜
刘浩
李国新
余江
Chen Xinhua;Lin Zhousheng;Chen Yuehong;Luo Jun;Zhu Yu;Liu Hao;Li Guoxin;Yu Jiang(Department of General Surgery Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第10期1191-1195,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家临床重点专科建设项目（2011170）
爱惜康卓越外科基金（320.2710.1819）
广东大学生科技创新培育专项资金（pdjha0094）
关键词
胃肿瘤
初始不可切除
转化治疗
研究
Stomach neoplasms, originally unresectable
Conversion therapy
Study
