A long-time survivor of alpha-fetoprotein-producing gastric cancer successfully treated by fluoropyrimidine-based chemotherapy: a case study
A long-time survivor of alpha-fetoprotein-producing gastric cancer successfully treated by fluoropyrimidine-based chemotherapy: a case study
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DOI：
10.1007/s12328-009-0105-9
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发表时间：
2009-10-01
影响因子：
1
通讯作者：
Miyazaki, Kohji
中科院分区：
文献类型：
--
作者：
Hiraki, Masatsugu;Sato, Seiji;Miyazaki, Kohji
1例67岁男性晚期胃癌伴淋巴结转移和门静脉癌栓患者接受S-1/顺铂治疗。首次访视时血清甲胎蛋白水平升高至836 ng/ml。化疗一个疗程后，患者病情稳定;血清甲胎蛋白水平也在短暂升高后降至626 ng/ml，因此进行了减容手术。进行了全胃切除术、远端胰腺切除术、脾切除术和区域淋巴结清扫术。切除的标本被诊断为甲胎蛋白生成型胃癌。在切除的淋巴结中没有转移灶，可能是由于术前化疗。术后继续使用S-1/顺铂治疗门静脉内残留的癌栓。一个疗程后瘤栓消失。然而，在肝十二指肠韧带中出现了直径为1.5 cm的淋巴结。因此，化疗改为紫杉醇单药治疗。紫杉醇单药治疗2个疗程后，淋巴结肿胀，因此在紫杉醇方案中加入50-脱氧-5-氟尿苷。5个疗程后淋巴结肿大消失，无新病灶，共治疗21个疗程。患者保持稳定超过8年，无复发。采用免疫组化方法回顾性分析耐药相关蛋白的表达情况，评价耐药情况。乳清酸磷酸核糖基转移酶的表达是强阳性的，在这种情况下，良好的结果可能已经与此结果。
A 67-year-old male with advanced gastric cancer and lymph node metastasis as well as a tumor embolus in the portal vein was treated by S-1/cisplatin therapy. The serum alpha-fetoprotein levels were elevated to 836 ng/ml at the first visit. After one course of chemotherapy, the patient showed stable disease; the serum level of alpha-fetoprotein also decreased to 626 ng/ml after a transient increase, and therefore reduction surgery was performed. A total gastrectomy with a distal pancreatectomy, splenectomy, and regional lymph node dissection was performed. The resected specimen was diagnosed to be alpha-fetoprotein-producing gastric cancer. There were no metastatic foci in the resected lymph nodes, presumably due to the preoperative chemotherapy. S-1/cisplatin therapy was continued after the operation to treat the remaining tumor embolus in the portal vein. After one course of this therapy, the tumor embolus disappeared. However, a lymph node measuring 1.5 cm in diameter appeared in the hepatoduodenal ligament. Therefore, the chemotherapy was changed to paclitaxel monotherapy. After 2 courses of paclitaxel monotherapy, the lymph node swelled, and thus 50-deoxy-5-fluorouridine was added to the paclitaxel regimen. After 5 courses of this regimen, the lymph node swelling disappeared without any other new lesions and a total of 21 courses were performed. The patient remained stable for over 8 years without recurrence. The expression of chemoresistance-related proteins was retrospectively analyzed by immunohistochemistry to evaluate the chemoresistance. The ortate phosphoribosyltransferase expression was strongly positive, and the good outcome in this case may have been associated with this result.