Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study
Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study
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DOI：
10.1007/s10120-016-0633-1
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发表时间：
2017-05-01
期刊：
影响因子：
7.4
通讯作者：
Takayama, Tetsuji
中科院分区：
文献类型：
--
作者：
Sato, Yasushi;Ohnuma, Hiroyuki;Takayama, Tetsuji
当远处转移被化疗控制时，转换治疗是不可切除的转移性胃癌的一种选择;然而，其可行性和疗效仍不清楚。本研究回顾性分析了100例初治不能切除的转移性胃癌患者接受多西他赛、顺铂和S-1（DCS）方案化疗的临床疗效，并对其可行性和有效性进行了评价。患者接受口服S-1（40 mg/m2，b.i.d.）第1-14天，静脉注射顺铂（60 mg/m2）和多西他赛（50-60 mg/m2），第8天，每3周一次。转换治疗是指患者在DCS化疗后可以接受R 0切除术，并且能够耐受根治性手术。100例患者中有33例实现了转换治疗，无围手术期死亡。33例患者中有28例（84.8%）实现了R 0切除，78.8%被定义为组织学化疗应答者。接受转换治疗的患者的中位总生存期（OS）为47.8个月（95%CI 28.0-88.5个月）。接受R 0切除术的患者的OS显著长于接受R1和R2切除术的患者（P = 0.0002）。在原发性不可切除的转移瘤患者中，10%的患者生存时间> 5年。在接受转换治疗的患者中，多变量分析显示，病理反应是OS的重要独立预测因素。DCS安全地诱导了高转换率，具有非常高的R 0和病理反应率，并与良好的预后相关;这些发现值得进一步的前瞻性研究。
Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes.One hundred unresectable metastatic gastric cancer patients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated. The patients received oral S-1 (40 mg/m(2) b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m(2)) and docetaxel (50-60 mg/m(2)) on day 8 every 3 weeks. Conversion therapy was defined when the patients could undergo R0 resection post-DCS chemotherapy and were able to tolerate curative surgery.Conversion therapy was achieved in 33/100 patients, with no perioperative mortality. Twenty-eight of the 33 patients (84.8 %) achieved R0 resection, and 78.8 % were defined as histological chemotherapeutic responders. The median overall survival (OS) of patients who underwent conversion therapy was 47.8 months (95 % CI 28.0-88.5 months). Patients who underwent R0 resection had significantly longer OS than those who underwent R1 and R2 resections (P = 0.0002). Of the patients with primarily unresectable metastases, 10 % lived > 5 years. Among patients who underwent conversion therapy, multivariate analysis showed that the pathological response was a significant independent predictor for OS.DCS safely induced a high conversion rate, with very high R0 and pathological response rates, and was associated with a good prognosis; these findings warrant further prospective investigations.