内容紹介
Comparison of Response to Chemotherapy between Ovarian and Extraovarian Metastasis of Gastric Cancer
Summary
Background: Ovarian metastasis of gastric cancer is thought to be less sensitive to chemotherapy. Methods: The subjects of this retrospective study were 15 gastric cancer patients with ovarian metastasis treated with first-line chemotherapy between January 1998 and April 2015. Response to chemotherapy was compared between ovarian metastasis and other measurable lesions; progression free survival(PFS), post progression survival(PPS), and overall survival(OS)were compared among the patients showing disease progression only at the ovary(group A), only at lesions other than the ovary(group B), and at both sites(group C). Results: The patient characteristics were as follows: median age 58 years(range 34-79); performance status 0/1, 4/11; histology of diffuse/intestinal type, 15/0; unilateral/bilateral ovarian metastasis, 5/10; metastasis to the peritoneum/lymph node/bone/pleura, 15/5/2/1; and chemotherapy regimen with S-1+cisplatin/S-1/methotrexate+5-fluorouracil(5-FU)/5-FU, 9/3/2/1. Partial response/stable disease/progressive disease were obtained in 1/11/3 patients, respectively. In 5 patients having measurable lesions in the ovary and lymph nodes, the median of the largest decrease in size after chemotherapy was 2.8%(range -8.2 to 31.7)at the ovary and 39.4%(range 5.4 to 75.4)at the lymph nodes(p=0.018). The number of patients in the groups A/B/C who experienced disease progression were 6/5/4, respectively; there were no differences in PFS(median 8.6/6.3/7.3 months, respectively). Group A showed the longest PPS and OS compared to group B and C(median OS 19.0/9.1/13.8 months and PPS 11.4/4.3/2.5 months, respectively). Conclusion: Compared with other metastatic sites, our findings suggest that ovarian metastasis of gastric cancer may show less chemo-response; however, its progression may have a smaller impact on survival.
要旨
背景: 卵巣は胃癌の好発転移部位であるが,他の転移部位に比べて化学療法が奏効しにくいといわれている。目的: 卵巣転移における腫瘍縮小効果の臨床的意義を明らかにする。方法: 対象は1998年1月～2015年4月に初回化学療法を受けた卵巣転移を伴う胃癌患者15例において,卵巣と卵巣以外の標的病変における腫瘍縮小効果および増悪部位別に予後を比較した。結果: 年齢中央値は58(34～79)歳,performance status 0/1が4/11例,卵巣転移は片側/両側が5/10例,全例が未分化腺癌,腹膜転移を伴い,5例で測定可能なリンパ節転移を有した。化学療法はS-1+cisplatin/S-1/methotrexate+5-fluorouracil(5-FU)/5-FUが9/3/2/1であり,最良腫瘍縮小効果は部分寛解/不変/増悪が1/11/3例であった 。卵巣転移とリンパ節転移の両方をもつ5例において,リンパ節転移における最大縮小率の中央値は39.4(5.4～75.4)%,卵巣では2.8(-8.2～31.7)%であった(p=0.018)。全例増悪まで治療が続けられたが,一次化学療法終了時点では卵巣転移のみの増大6例(A群),卵巣以外病変のみの増大5例(B群),4例で卵巣転移・卵巣以外病変ともに増大(C群)を認めた。これら3群における無増悪生存期間および全生存期間の中央値は8.6/6.3/7.3か月および19.0/9.1/13.8か月であり,増悪後の生存期間は11.4/4.3/2.5であった。結論: 胃癌の卵巣転移は他の転移に比して腫瘍縮小効果が表れにくく,卵巣転移のみの増大は増悪後の予後に大きな影響を与えない可能性が示唆された。
目次
Summary
Background: Ovarian metastasis of gastric cancer is thought to be less sensitive to chemotherapy. Methods: The subjects of this retrospective study were 15 gastric cancer patients with ovarian metastasis treated with first-line chemotherapy between January 1998 and April 2015. Response to chemotherapy was compared between ovarian metastasis and other measurable lesions; progression free survival(PFS), post progression survival(PPS), and overall survival(OS)were compared among the patients showing disease progression only at the ovary(group A), only at lesions other than the ovary(group B), and at both sites(group C). Results: The patient characteristics were as follows: median age 58 years(range 34-79); performance status 0/1, 4/11; histology of diffuse/intestinal type, 15/0; unilateral/bilateral ovarian metastasis, 5/10; metastasis to the peritoneum/lymph node/bone/pleura, 15/5/2/1; and chemotherapy regimen with S-1+cisplatin/S-1/methotrexate+5-fluorouracil(5-FU)/5-FU, 9/3/2/1. Partial response/stable disease/progressive disease were obtained in 1/11/3 patients, respectively. In 5 patients having measurable lesions in the ovary and lymph nodes, the median of the largest decrease in size after chemotherapy was 2.8%(range -8.2 to 31.7)at the ovary and 39.4%(range 5.4 to 75.4)at the lymph nodes(p=0.018). The number of patients in the groups A/B/C who experienced disease progression were 6/5/4, respectively; there were no differences in PFS(median 8.6/6.3/7.3 months, respectively). Group A showed the longest PPS and OS compared to group B and C(median OS 19.0/9.1/13.8 months and PPS 11.4/4.3/2.5 months, respectively). Conclusion: Compared with other metastatic sites, our findings suggest that ovarian metastasis of gastric cancer may show less chemo-response; however, its progression may have a smaller impact on survival.
要旨
背景: 卵巣は胃癌の好発転移部位であるが,他の転移部位に比べて化学療法が奏効しにくいといわれている。目的: 卵巣転移における腫瘍縮小効果の臨床的意義を明らかにする。方法: 対象は1998年1月～2015年4月に初回化学療法を受けた卵巣転移を伴う胃癌患者15例において,卵巣と卵巣以外の標的病変における腫瘍縮小効果および増悪部位別に予後を比較した。結果: 年齢中央値は58(34～79)歳,performance status 0/1が4/11例,卵巣転移は片側/両側が5/10例,全例が未分化腺癌,腹膜転移を伴い,5例で測定可能なリンパ節転移を有した。化学療法はS-1+cisplatin/S-1/methotrexate+5-fluorouracil(5-FU)/5-FUが9/3/2/1であり,最良腫瘍縮小効果は部分寛解/不変/増悪が1/11/3例であった 。卵巣転移とリンパ節転移の両方をもつ5例において,リンパ節転移における最大縮小率の中央値は39.4(5.4～75.4)%,卵巣では2.8(-8.2～31.7)%であった(p=0.018)。全例増悪まで治療が続けられたが,一次化学療法終了時点では卵巣転移のみの増大6例(A群),卵巣以外病変のみの増大5例(B群),4例で卵巣転移・卵巣以外病変ともに増大(C群)を認めた。これら3群における無増悪生存期間および全生存期間の中央値は8.6/6.3/7.3か月および19.0/9.1/13.8か月であり,増悪後の生存期間は11.4/4.3/2.5であった。結論: 胃癌の卵巣転移は他の転移に比して腫瘍縮小効果が表れにくく,卵巣転移のみの増大は増悪後の予後に大きな影響を与えない可能性が示唆された。