摘要
胃癌是我国最常见的恶性肿瘤之一,临床收治的胃癌患者以进展期为主。近年来,随着药物治疗的进步,对于无法手术的Ⅳ期胃癌采取以药物治疗为主的综合治疗后,可以使部分病例肿瘤降期,从而获得根治手术的机会,部分接受手术治疗的患者从而获得了长期生存的机会。REGATTA研究结果证实,姑息手术+化疗不能改善Ⅳ期胃癌患者的远期生存。新辅助腹腔+静脉化疗可以使部分伴有腹膜转移的Ⅳ期胃癌病例降期,接受手术治疗并获得长期生存的机会。腹腔热灌注化疗联合PHOENIX研究方案,有望提高伴有腹膜转移Ⅳ期胃癌病例的转化手术率。以紫杉醇为基础的三药化疗可以使部分无法手术的晚期胃癌降期,获得手术机会,从而提高无疾病进展生存和总生存率,已成为Ⅳ期胃癌转化治疗的基石。抗血管生成靶向药物阿帕替尼联合紫杉醇等化疗药物安全可靠,可以作为Ⅳ期胃癌转化治疗的备选方案之一,为细胞毒药物联合靶向药物提供了新思路。免疫治疗时代,免疫药物联合应用及一线应用已是业内共识。针对晚期Her-2阳性食管胃结合部腺癌病例,化疗+抗Her-2靶向药+抗PD-1单抗的四药联合一线治疗的成功探索,开辟了Ⅳ期胃癌转化治疗的新时代。胃癌是异质性非常高的恶性肿瘤,以Yoshida分型为代表的Ⅳ期胃癌分类法是以影像学为基础的,未来应该结合基因检测等手段,制定更合理的Ⅳ期胃癌分类方法,据此制定Ⅳ期胃癌个体化精准转化治疗方案,有效提高Ⅳ期胃癌患者的远期生存。
Gastric cancer is one of the most common malignancy in China.Most of the patients of gastric cancer treated clinically are in advanced stage.In the past years,with the progress of anti-cancer drug therapy,after the comprehensive treatment based on drugs therapy of inoperative stage IV gastric cancer,some cases can reduce the tumor stage and get the opportunity of radical operation.Some of the patients who underwent surgical treatment can get the chance of long-term survival.The results of REGATTA trial confirmed that palliative surgery plus chemotherapy could not improve the long-term survival of patients with stage IV gastric cancer.Neoadjuvant intraperitoneal plus intravenous chemotherapy can reduce the tumor stage of some cases of stage IV gastric cancer with peritoneal metastasis and receive surgical treatment,so as to gain the chance of long-term survival.Regimen of intraperitoneal hyperthermia chemotherapy combined with PHOENIX trial is expected to improve the conversion operation rate of gastric cancer with peritoneal metastasis.Paclitaxel-based three-drug chemotherapy can reduce the tumor stage of some inoperable advanced gastric cancer and obtain the opportunity of radical operation,improving the disease-free survival rate and overall survival rate of patients,thus has become the cornerstone of conversion therapy for stage IV gastric cancer.Antiangiogenic targeted drug apatinib combined with paclitaxel is safe and reliable,and can be used as an alternative for the conversion therapy of stage IV gastric cancer,which provides a new idea for cytotoxic drugs combined with targeted drugs.In the era of immunotherapy,the combined application and first-line application of immunosuppressive drugs has become a clinical consensus.For advanced Her-2 positive esophagogastric junction adenocarcinoma cases,the successful exploration of the four-drug combination of chemotherapy+anti-Her-2 targeted drugs+anti-PD1 monoclonal antibody combined with the first-line therapy has opened up a new era of transformational therapy
作者
梁寒
Liang Han(Department of Gastric Surgery,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Centerfor Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2021年第2期107-111,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(81572372)
国家重点研发项目(2016YFC1303202、2017YFC0908304)。
关键词
胃肿瘤
Ⅳ期
转化治疗
外科手术
Stomach neoplasmas
Stage IV
Conversion
Surgery
