Salvage surgery after chemotherapy with S-1 plus cisplatin for α-fetoprotein-producing gastric cancer with a portal vein tumor thrombus: a case report

BMC Surgery

Tetsuro Ishikawa¹  Kosei Hirakawa³  Mayumi Inaba²  Takeshi Hori¹  Kenji Kuroda¹  Masashige Tendo¹  Bunzo Nakata¹  Shigetomi Nakao¹ 

[1] Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka 582-0005, Japan;Department of Pathology, Osaka City University Graduate School of Medicine, 1-4-3 AsahimachiAbeno-ku, Osaka 545-8585, Japan;Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 AsahimachiAbeno-ku, Osaka 545-8585, Japan

关键词: Portal vein tumor thrombus;    α-fetoprotein-producing gastric cancer;    Neoadjuvant chemotherapy;   

Others  :  1090545
DOI  :  10.1186/1471-2482-15-5

 received in 2014-09-12, accepted in 2015-01-08,  发布年份 2015

【 摘 要 】

Background

Patient with α-Fetoprotein (AFP)-producing gastric cancer usually has a short survival time due to frequent hepatic and lymph node metastases. Gastric cancer with portal vein tumor thrombus (PVTT) is rare and has an extremely poor prognosis.

Case presentation

A 63-year-old man was found to have a huge Type 3 gastric cancer with a PVTT and a highly elevated serum AFP level. Chemotherapy with S-1 plus cisplatin was given to this patient with unresectable gastric cancer for 4 months. The serum AFP level decreased from 6,160 ng/mL to 60.7 ng/mL with chemotherapy. Since the PVTT disappeared after the chemotherapy, the patient underwent total gastrectomy. Histological findings of the primary tumor after chemotherapy showed poorly differentiated adenocarcinoma without hepatoid cells and viable tumor cells remaining in less than 1/3 of the neoplastic area of mucosa and one lymph node. The cancerous cells were immunohistochemically stained by anti-AFP antibody. The patient has survived for 48 month without recurrence.

Conclusions

AFP-producing gastric cancer with a PVTT has an extremely poor prognosis, but long-term survival was achieved for this dismal condition by salvage surgery after chemotherapy.

【 授权许可】

   
2015 Nakao et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Kono K, Amemiya H, Sekikawa T, Iizuka H, Takahashi A, Fujii H, et al.: Clinicopathologic features of gastric cancers producing alpha-fetoprotein. Dig Surg 2002, 19:359-365.
• [2]Adachi Y, Tsuchihashi J, Shiraishi N, Yasuda K, Etoh T, Kitano S: AFP-producing gastric carcinoma: multivariate analysis of prognostic factors in 270 patients. Oncology 2003, 65:95-101.
• [3]Ishigami S, Natsugoe S, Nakashima H, Tokuda K, Nakajo A, Okumura H, et al.: Biological aggressiveness of alpha-fetoprotein (AFP)-positive gastric cancer. Hepatogastroenterology 2006, 53:338-341.
• [4]Inoue M, Sano T, Kuchiba A, Taniguchi H, Fukagawa T, Katai H: Long-term results of gastrectomy forα-fetoprotein-producing gastric cancer. Br J Surg 2010, 97:1056-1061.
• [5]Takahashi Y, Ohta T, Mai M: Angiogenesis of AFP producing gastric carcinoma: correlation with frequent liver metastasis and its inhibition by anti-AFP antibody. Oncol Rep 2004, 11:809-813.
• [6]Kamei S, Kono K, Amemiya H, Takahashi A, Sugai H, Ichihara F, et al.: Evaluation of VEGF and VEGF-C expression in gastric cancer cells producing alpha-fetoprotein. J Gastroenterol 2003, 38:540-547.
• [7]Amemiya H, Kono K, Mori Y, Takahashi A, Ichihara F, Iizuka H: High frequency of c-Met expression in gastric cancers producing alpha-fetoprotein. Oncology 2000, 59:145-151.
• [8]Kataoka H, Miura Y, Joh T, Seno K, Tada T, Tamaoki T, et al.: α-Fetoprotein producing gastric cancer lacks transcription factor ATBF1. Oncogene 2001, 20:869-873.
• [9]Fujii H, Ichikawa K, Takagaki T, Nakanishi Y, Ikegami M, Hirose S, et al.: Genetic evolution of alpha fetoprotein producing gastric cancer. J Clin Pathol 2003, 56:942-949.
• [10]Kinjo T, Taniguchi H, Kushima R, Sekine S, Oda I, Saka M, et al.: Histologic and immunohistochemical analyses of α-fetoprotein-producing-cancer of the stomach. Am J Surg Pathol 2012, 36:56-65.
• [11]Liu X, Sheng W, Wang Y: An analysis of clinicopathological features and prognosis by comparing hepatoid adenocarcinoma of the stomach with AFP-producing gastric cancer. J Surg Oncol 2012, 106:299-303.
• [12]Ando E, Tanaka M, Yamashita F, Kuromatsu R, Yutani S, Fukumori K, et al.: Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Analysis of 48 cases. Cancer 2002, 95:588-595.
• [13]Tanaka A, Takeda R, Mukaihara S, Hayakawa K, Takasu K, Terajima H, et al.: Tumor thrombi in the portal vein system originating from gastrointestinal tract cancer. J Gastroenterol 2002, 37:220-228.
• [14]Katagiri S, Yamamoto M: Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus. Surg Today 2014, 44:219-226.
• [15]The Japanese Society of Pathology (Ed): Annual of the pathological autopsy cases in Japan [in Japanese]. Aichi: Jinshikai; 1998.
• [16]Eom BW, Lee JH, Lee JS, Kim MJ, Ryu KW, Choi IJ, et al.: Survival analysis of gastric cancer patients with tumor thrombus in the portal vein. J Surg Oncol 2012, 105:310-315.
• [17]Kochi M, Fujii M, Kaiga T, Takahashi T, Morishita Y, Kobayashi M, et al.: FLEP chemotherapy for alpha-fetoprotein-producing gastric cancer. Oncology 2004, 66:445-449.
• [18]Japanese Gastric Cancer Association: Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer 2011, 14:113-123.
• [19]Japanese Gastric Cancer Association: Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011, 14:101-112.
• [20]Araki T, Suda K, Sekikawa T, Ishii Y, Hihara T, Kachi K: Portal venous tumor thrombosis associated with gastric adenocarcinoma. Radiology 1990, 174:811-814.
• [21]Lee MW, Lee JY, Kim YJ, Park EA, Choi JY, Kim SH, et al.: Gastric hepatoid adenocarcinoma: CT findings. Abdom Imaging 2007, 32:293-298.
• [22]Saitoh H, Boku N, Ohtsu A, Hironaka S, Miyamoto S, Hamamoto Y, et al.: Five-year survivor with liver metastasis from gastric cancer successfully treated with systemic chemotherapy. Gastric Cancer 2000, 3:106-109.
• [23]Yamaguchi M, Midorikawa T, Saitoh M, Kadokura S, Miyagawa K, Sanada Y, et al.: Tumor thrombus in the splenic vein originated from gastric carcinoma that produced α-fetoprotein. Hepatogastroenterology 2003, 50:1693-1696.
• [24]Inoue K, Nakane Y, Kogire M, Fujitani K, Kimura Y, Imamura H, et al.: Phase II trial of preoperative S-1 plus cisplatin followed by surgery for initially unresectable locally advanced gastric cancer. Eur J Surg Oncol 2012, 38:143-149.
• [25]Iwasaki Y, Sasako M, Yamamoto S, Nakamura K, Sano T, Katai H, et al.: Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol 2013, 107:741-745.