综合治疗79岁进展期胃癌1例

基础医学与临床 ›› 2021, Vol. 41 ›› Issue (7): 1043-1046.

综合治疗79岁进展期胃癌1例

苏鹏飞¹, 蒋林¹, 章盈婧¹, 郭博¹, 马志强¹, 周炜洵², 于健春^1*

1.中国医学科学院北京协和医学院北京协和医院基本外科,北京 100730;
2.中国医学科学院北京协和医学院北京协和医院病理科,北京 100730

收稿日期:2020-12-07 修回日期:2021-04-27 出版日期:2021-07-05 发布日期:2021-06-17
通讯作者: *yu-jch@163.com
基金资助:
北京市科学技术委员会基金(D171100006517002)

A 79-year-old patient with advanced gastric cancer who received comprehensive therapy

SU Peng-fei¹, JIANG Lin¹, ZHANG Ying-jing¹, GUO Bo¹, MA Zhi-qiang¹, ZHOU Wei-xun², YU Jian-chun^1*

1. Department of General Surgery;
2. Department of Pathology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China

Received:2020-12-07 Revised:2021-04-27 Online:2021-07-05 Published:2021-06-17
Contact: *yu-jch@163.com

摘要/Abstract

摘要： 目的探讨老龄进展期胃癌患者的治疗现状与难题,为寻求理想治疗模式提供参考。方法收集1例老龄进展期胃癌患者的诊疗资料并结合相关文献进行探讨。结果患者为一例79岁老龄男性,结合胃镜、影像学和病理学检查结果临床诊断为胃底腺癌(cT4a-bN2Mx)。该患者首先行新辅助同步放射治疗和化学药物治疗,3程治疗结束后行术前评估显示肿瘤发生临床降期(cT3-4N1Mx),遂予实施胃癌根治手术,术后替吉奥(S1)单药口服化学治疗,营养治疗贯穿全程管理。患者术后至今2年半规律门诊随访,未见肿瘤复发、转移,一般状况良好。结论包括新辅助放射治疗、化学药物治疗、手术治疗和营养治疗等在内的序贯性综合疗法对于进展期胃癌老龄患者的治疗展现出长远意义和潜力,值得在临床上进一步验证和推广。

关键词: 进展期胃癌, 老龄患者, 综合治疗, 病例报告

Abstract: Objective To discuss the current situation and challenge to the treatment strategy for elderly patients with advanced gastric cancer and provide reference for the exploration of ideal treatment methods. Methods Collect the clinical material of an elderly patient with advanced gastric cancer, and the relevant literatures were reviewed. Results A 79-year-old man was clinically diagnosed as adenocarcinoma on the fundus of stomach (cT4a-bN2Mx). After the third course of neo-adjuvant concurrent chemo-radiotherapy, a remarkable reduction and down-staging was achieved (cT3-4N1Mx), then followed by radical gastrectomy for gastric cancer. S1 was used alone for the postoperative chemotherapy. The patient received nutritional therapy in the full treatment course, and the physical condition was satisfactory without tumor metastasis and relapse two years and a half after the surgery. Conclusions The sequentially comprehensive therapy suggestes a treatment therapy for elderly patients with advanced gastric cancer, and deserves further verification and promotion clinically.

Key words: advanced gastric cancer, elderly patients, comprehensive therapy, case report

中图分类号:

R656.6

苏鹏飞, 蒋林, 章盈婧, 郭博, 马志强, 周炜洵, 于健春. 综合治疗79岁进展期胃癌1例[J]. 基础医学与临床, 2021, 41(7): 1043-1046.

SU Peng-fei, JIANG Lin, ZHANG Ying-jing, GUO Bo, MA Zhi-qiang, ZHOU Wei-xun, YU Jian-chun. A 79-year-old patient with advanced gastric cancer who received comprehensive therapy[J]. Basic & Clinical Medicine, 2021, 41(7): 1043-1046.

参考文献

[1]Sitarz R, Skierucha M, Mielko J, et al. Gastric cancer: epidemiology, prevention, classification, and treatment[J]. Cancer Manag Res, 2018, 10: 239-248.
[2]Hashimoto T, Kurokawa Y, Mikami J, et al. Postopera-tive long-term outcomes in elderly patients with gastric cancer and risk factors for death from other diseases[J]. World J Surg, 2019, 43: 2885-2893.
[3]D'Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma[J]. Ann Surg, 2004, 240: 808-816.
[4]Hu Y, Hu D, Li W, et al. Neoadjuvant chemotherapy brings more survival benefits than postoperative chemotherapy for resectable gastric cancer: a meta-analysis of randomized controlled trials[J]. J Buon, 2019, 24: 201-214.
[5]Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition[J]. Therap Adv Gastroenterol, 2013, 6: 157-167.
[6]Oyama K, Fushida S, Kinoshita J, et al. Early enteral nutrition for gastric cancer patients with extended surgery[J]. Gan To Kagaku Ryoho, 2017, 44: 1491-1493.
[7]Miyata H, Yano M, Yasuda T, et al. Randomized study of the clinical effects of omega-3 fatty acid-containing enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer[J]. Nutrition, 2017, 33: 204-210.
[8]Park DJ, Park YS, Ahn SH, et al. Laparoscopic proximal gastrectomy as a surgical treatment for upper third early gastric cancer[J]. Korean J Gastroenterol, 2017, 70: 134-140.
[9]吴国豪, 毛翔宇. 成人围手术期营养支持指南[J]. 中华外科杂志, 2016, 54: 641-657.
[10]孟庆彬, 于健春, 康维明, 等. 空肠置管肠内营养对胃癌患者术后生活质量的影响[J]. 中国医学科学院学报, 2013, 35: 332-336.
[11]Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition[J]. Clin Nutr, 2020, 39: 5-22.
[12]Richter E, Denecke A, Klapdor S, et al. Parenteral nutrition support for patients with pancreatic cancer-improvement of the nutritional status and the therapeutic outcome[J]. Anticancer Res, 2012, 32: 2111-2118.