ФАРМАТЕКА » Конверсионное лечение при раке желудка IV стадии: обзор факторов прогноза и критериев отбора пациентов по литературным данным

Конверсионное лечение при раке желудка IV стадии: обзор факторов прогноза и критериев отбора пациентов по литературным данным

DOI: https://dx.doi.org/10.18565/pharmateca.2023.6-7.16-27

Бесова Н.С.
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина, Москва, Россия

Обоснование. При диссеминированном раке желудка (РЖ) основным методом лечения является противоопухолевая лекарственная терапия. Однако прогноз при РЖ IV стадии остается неблагоприятным, в связи с чем возродился интерес
к комбинации химиотерапии с хирургическим лечением.
Влияние паллиативной гастрэктомии на выживаемость больных РЖ IV стадии. Роль паллиативной гастрэктомии при РЖ IV стадии оценена в ряде ретроспективных анализов, давших противоречивые результаты. Результаты исследования REGATTA показали, что паллиативная гастрэктомия с последующей химиотерапией не увеличивает выживаемости больных. В литературе продолжается дискуссия по поводу влияния паллиативной гастрэктомии на выживаемость.
Влияние конверсионного лечения на выживаемость больных РЖ IV стадии. Термин «conversion therapy» – конверсионное лечение, отражает лечебную концепцию, при которой в результате эффекта противоопухолевой терапии исходно неоперабель-ный диссеминированный процесс переводится в резектабельное состояние с возможностью полного хирургического удаления опухолевых проявлений. В статье представлен тематический обзор исследований, почти все из которых ретроспективные. По данным проспективного исследования III фазы Neo-REGATTA, выживаемость больных, получивших конверсионное лечение, значимо (p<0,0001) выше, чем в группе химиотерапии. Согласно результатам мета-анализов, оптимальной стратегией лечения больных РЖ IV стадии является комбинация химиотерапии с последующим оперативным лечением.
Конверсионное лечение: факторы прогноза. В результате многофакторных Cox-анализов, проведенных разными авторами, выделены следующие факторы прогноза: 1) удовлетворительный функциональный статус пациента ECOG 0-1; 2) выполнение хирургического лечения в объеме R0; 3) наличие только 1-й зоны отдаленного метастазирования; 4) химиотерапия на первом этапе лечения; 5) достижение объективного эффекта химиотерапии к моменту операции; 6) проведение перед операцией не менее 6–8 курсов химиотерапии.
Критерии отбора пациентов для конверсионного лечения. С учетом гетерогенности, различной биологии
и распространенности опухоли предложено разделение больных РЖ IV стадии на четыре категории: 1) пациенты c потенциально операбельным процессом без метастазов по брюшине; 2) пациенты с погранично операбельным процессом без метастазов по брюшине; 3) пациенты с макроскопически определяемой диссеминацией по брюшине, но без других отдаленных метастазов;
4) пациенты с макроскопически определяемыми метастазами по брюшине и другими отдаленными метастазами. Кандидатами на конверсионное будут пациенты 1-й и 2-й категорий, реже – 3-й и единичные больные 4-й категории. Представлены критический анализ классификации и результаты ее практического применения.
Заключение. Для определения роли хирургического метода в лечении больных РЖ IV стадии необходимы рандомизированные проспективные исследования.

Ключевые слова: олигометастатическая болезнь, конверсионная хирургия, конверсионное лечение, химиотерапия, рак желудка

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Автор для связи: Наталия Сергеевна Бесова, к.м.н., ведущий науч. сотр. отделения противоопухолевой лекарственной терапии № 2 отдела лекарственного лечения, Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина, Москва, Россия; besovans@mail.ru; ORCID: http://orcid.com/0000-0002-1693-0523

Конверсионное лечение при раке желудка IV стадии: обзор факторов прогноза и критериев отбора пациентов по литературным данным

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