6
Ȇ ݽட፣ दᕝӓзளޠᕝϟΚȂᕝԬκ ౦௷ӫзಒΡȄदᕝηѯᢋளޠΫτඍ ܓလድϟΚȂᐄѯᢋፐҢᆌւഌୋဎޠಜॏၦਠᡘұȂदᕝӼҢӶԒឮ50 п ȂйτഌӌೞຩᘟਣഎءԥޒȄᗷด दᕝޠҢ౦ԥί७ᗎ༗Ȃկூޠ ٯءԥЎЋӼйϬดାԬκ౦ޠᕝȄदᕝ Ӷݎ՚РϛӤঢ়ȃϛӤᆎࢻޠ౦ȃூ ԓȃݾᕜРԓІᘿഎԥᡘޠৰȄկ ӓзᄈदᕝݾޠԚᕽҭϬดпݎР ޠСȃᗻഷԂȂѻউޠКޠࡤԇ౦ሊାዊ जঢ়Ȅ दᕝစႇϲຝᜣϹб(endoscope biopsy) ౪ຩᘟ Ȃள௦ ڨदᕝ ޠϸ Ȃ ڐϜѠєΠϲຝᜣᖑ ݱ(EUS, endoscopic ultrasonography)ȂဝഌႬဟᘟቺ௮ (abdomen CT) ȂഌX- ӏІαϾၿኈ قӗޠȂᖞטᚃ৲ٸޠࢦᆤӬ๗ݏ ϸпւݾޠᕜȄ౫ϭदᕝݾޠᕜР ݳଷΠཌྷК ޠȂϲຝᜣϹଷȂϾᏱ ݾᕜȂռݾᕜȂዀૉݾᕜІጤݾᕜȂөР ८എԥߞޠȄᄈदᕝݾޠᕜዂԓ ηҦዀD2 Кܗextensive ᘘτКȂᅛᅛ ޠпІᕝϸٿ໕ॐښ(tailored approach)ޠݾٺᕜዂԓȄ ԞथᕜЅथᕜ ҭदᕝӶݾᕜαΚпTNMޠϸ л(ҭAJCC 7th edition)ȂկΠРॐ ݾᕜРଭᖞטαளदᏪᕝޠϸ ᆣӫᚂ ΙૡѴऋ ༁ড় थᕜ ݽᕛᗍ༖ ԟІܓȄԟदᕝ(EGC, early gastric cancer) ᕝ४Ӷदᘈጱ(mucosa) ܗᘈጱί (submucosa) ȂՅदᕝ(AGC, Advanced gastric cancer)ᕝϑҜژदᏪڿޠԥՋቺ (muscularis propia)ܗȄՅӕпВသᙾಌ ϡޠႲข؛ٿݾᕜРଭȄ(შΚ) ყΙ ϱຜᜢഋϸଶ ߗԒٿϲຝᜣޠހၽңІຩᘟޠȂ ᄈԟຩᘟяޠٿϾၿလድєॶၿȃद ІτဘȂϑစԥΩٻңϲຝᜣޠ حޠϹଷݾ1 Ȅ࿌ดȂᄈߩளԟ ޠदᕝȂӱВသᙾಌޠᐡ౦մȂಓӬᎍᔗ ޠحစϲຝᜣϹଷηѠຝݾܓϹଷȂ ҭݾޠࠊᕜᎍᔗ2 ϵϸпίйՉಂءԥዜ ޠᘈጱϲᕝ(cT1a, mucosa) 2 ȄစϲຝᜣϹଷ ޠလድዀҐሰစ౪ᚃ৲ၐಡޠᔯຝٿց လድޠϸϾโ(differentiation) ȂԥณВ ޠҜ(lymphovascular invasion) ІϹଷ (margin) ȄԄݏϹଷ๗ݏϸϾԂጣ йณВᆔޠҜȂᖞטαѠຝݾ ܓݾᕜȄαѠϸϲຝᜣᘈጱϹଷ(EMR, 2015ԑ59ڢ7 Ѯѕѿᚂৱϴѐ 43

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Page 1: s Í - tma.org.t · ð Ú c % \ } [ s Í Endoscopic Mucosal Resection) ò # 1 ¯ z ¦ Û(ESD, Endoscopic Submucosal Dissection) EMR £ ó ¬ $ } ¡ 1

50

(endoscope biopsy)

(EUS, endoscopic ultrasonography)

(abdomen CT) X-

D2 extensive(tailored

approach)

TNM( AJCC 7th edition)

(EGC, early gastric cancer) (mucosa)

(submucosa) (AGC, Advanced gastric cancer)(muscularis propia)

( )

1

2(cT1a, mucosa)2

(differentiation)(lymphovascular invasion)

(margin)

(EMR,

2015 59 7 43

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Endoscopic Mucosal Resection)(ESD, Endoscopic Submucosal

Dissection) EMR2

ESD

(IT-knife)ESD 2

(en-bloc resection)

(Radical Gastrectomy)

D2 (D2 dissection)2,3

(Extensive dissection) D2 D2

dissection 2006 (D3)

D1 5 (59.5% vs 53.6%, P=0.04)

4 1990 (British and Dutch trial)D2 dissection

D 22010

Dutch trial Lancet Oncology 15D2 dissection

5

(IGCSG) 2010D2 dissection

D16 D2

(Advanced gastric cancer)(Para-aortic Lymph

Node Dissection, PAND)PAND

5 20% 2000

PAND 90PAND (JCOG9501)

2008 NEJM7 PAND

8%PAND

WhippleAppleby

(R0)

5 90%90(function preserving

2015 59 7 44

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gastrectomy) (limited gastrectomy) D1+

( D2 )8

Kitano9 1994B1 (less invasive

surgery)D2

Phase 2 (JACOG 0703)

10

Phase 3 study JCOG 0912KLASS

11,12

(Adjuvant Chemotherapy)

D 2

TS-1( ®)

ACTS-GC phase IIID2 TS-1

10% 5 12.3% 5II-III

TS-1 13,14

phase 3 CLASSIC CapecitabineOxaliplatin (XELOX) 3

14%15

5-FU D2

MAGIC trial

16

(Neoadjuvant)

(tumor down staging)TS-1 Cisplatin

87.8% 348%17

fluoropyrimidine(5-FU) platinum

2015 59 7 45

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( ) HER2fluoropyrimidine platinum

t r a s t u z u m a b (Herceptin® ) phase 3 ToGA 18 trastuzumab

(13.8 vs. 11.1 months; HR 0.74; p=0.0046)

phase 3 anti-VEGF antibody, anti-EGFR antibody, mTOR inhibitor

(chemoradiation)D1 McDonald (Int 0116)

D2

(Polysaccharide)

(Polysaccharide K, Krestin®)19,20

(Multimodality therapy)

1. --. 2013; 24:

19-28.

2. : J apanese gas t r i c cancer treatment guidelines 2010 (ver.3). Gastric Cancer: online 14 May 2011.

3. Saka M, Morita S, Fukagawa T: Present and Future Status of Gastric Cancer Surgery. Jpn J Clin Oncol 2011; 41(3): 307-13.

4. Wu CW, Hsiung CA, Lo SS: Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006; 7: 309-15.

5. Songun I, Putter H, Kranenbarg EM: Surgical

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treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11: 439-49.

6. Degiuli M, Sasako M, Ponti A: Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 2010; 97: 643-9.

7. S a s a k o M , S a n o T, Ya m a m o t o S : D 2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008; 359: 453-62

8. Tsujitani S, Oka S, Saito H: Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery 1999; 125: 148-54.

9. Kitano S, Iso Y, Moriyama M: Laparoscopic-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4: 146-8

10. Katai H, Sasako M, Fukuda H, et al: Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 2010; 13: 238-44.

11. Nakamura K, Katai H, Mizusawa J, et al: th Nodal Dissection for Clinical Stage IA/IB Gastric Cancer (JCOG0912). Jpn J Clin Oncol 2013; 43: 324-7.

12. K i m H H , H y u n g W J , C h o G S , e t a l : Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010; 251: 417-20.

13. Sakuramoto S, Sasako M, Yamaguchi T, et al: Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007; 357: 1810–20.

14. Sasako M, Sakuramoto S, Katai H, et al: Five-Year Outcomes of a Randomized Phase III Trial Comparing Adjuvant Chemotherapy With S-1 Versus Surgery Alone in Stage II or III Gastric Cancer. J Clin Oncol 2011; 29: 4387–93

15. Bang YJ, Kim YW, Yang HK, et al: Adjuvant capecitabine and oxaliplatin for gastric cancer: results of the phase III CLASSIC trial. 2011 ASCO Annual Meeting. J Clin Oncol 2011; 29: LBA4002.

16. Cunningham D, Allum WH, Stenning SP, et al: Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20.

17. Kochi M, Fujii M, Kanamori N, et al: Phase II Study of Neoadjuvant Chemotherapy With S-1 and CDDP in Patients With Lymph Node Metastatic Stage II or III Gastric Cancer. Am

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J Clin Oncol 2014 Mar 21. [Epub ahead of print]

18. Bang YJ, Cutsem EV, Andrea F, et al: for t rea tment of HER2-pos i t ive advanced gastr ic or gastro-oesophageal junct ion cancer (ToGA): a phase 3, open-label , randomised controlled trial. The Lancet 2010; 376(9742): 687-97.

19. Hiroaki N, Akihiko K, Shigetoyo S, et al: Efficacy of Immunochemotherapy as Adjuvant Treatment after Curative Resection of Gastric Cancer. Lancet 1994; 343: 1122-6.

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