위암(pT3N0 or node-positive disease)에서 adjuvant therapy

이전 블로그 :

1. 위암 T2N0M0(stage IB)에서 항암 치료(adjuvant chemotherapy)

https://blog.naver.com/sjloveu2/221561618206

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Pathologic T3N0 or node-positive disease

T3-4N0인 모든 환자와 N1 환자(T1N1 stage IB를 포함한)에서 수술 단독보다는 adjuvant therapy를 제안합니다.

 

Pathological (pTNM)
When T is...	And N is...	And M is...	Then the stage group is...

T1	N1	M0	IB
T2	N0	M0	IB
T1	N2	M0	IIA
T2	N1	M0	IIA
T3	N0	M0	IIA
T1	N3a	M0	IIB
T2	N2	M0	IIB
T3	N1	M0	IIB
T4a	N0	M0	IIB
T2	N3a	M0	IIIA
T3	N2	M0	IIIA
T4a	N1	M0	IIIA
T4a	N2	M0	IIIA
T4b	N0	M0	IIIA

Adjuvant therapy에는 ①chemoradiotherapy plus chemotherapy, ②chemotherapy alone이 있으며 적절한 D2 lymph node dissection(including perigastric [D1] nodes as well as those along the left gastric artery, common hepatic artery, celiac artery, splenic hilum, and splenic artery [D2 lymph nodes], with the goal of examining 16 or more lymph nodes)을 시행하지 않는 환자에서는 chemotherapy alone보다는 chemoradiotherapy plus chemotherapy를 제안합니다. 적절한 lymphadenectomy를 시행한 환자에서는 RT는 생략될 수 있으나 chemoradiotherapy plus chemotherapy는 여전히 선택 가능하며 특히 node-positive disease인 경우에는 그러합니다.

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REF. UpToDate 2019.06.17