21例肺肉瘤样癌临床分析和靶向治疗探讨

Molecular targeted therapy and clinical analysis of pulmonary sarcomatoid carcinoma in 21 cases

目的探讨肺肉瘤样癌的临床特点、诊断和治疗方法,提高对该疾病的认识。方法回顾性分析21例肺肉瘤样癌患者的临床资料特点,分别对临床特征、影像表现、病理特征、治疗和预后进行分析。结果肺肉瘤样癌临床表现与其他类型非小细胞肺癌相似,影像和病理特征与其他类型非小细胞肺癌比较存在一定差异,研究中11例复发或晚期PSC患者中有7例单纯化疗,2周期后评价疗效,获得PR2例,SD2例,PD3例,ORR28.6%(2/7),DCR57.1%(4/7),中位OS和PFS分别为10.5个月,3.5个月;研究中2例EGFR突变的Ⅳ期患者应用吉非替尼分子靶向治疗,其中1例患者获益,另1例患者无效。1例ALK基因融合阳性患者化疗2周期进展后应用克唑替尼症状缓解,肿瘤稳定了4个月。有4例ⅢB~Ⅳ期患者应用恩度联合含铂方案化疗,其中PR2例,SD1例,PD1例;1例Ⅳ期患者化疗2周期进展后,使用阿帕替尼抗肿瘤血管生成治疗无效。结论肺肉瘤样癌临床罕见,生存期短,预后较差,目前尚无标准治疗方案,肺肉瘤样癌的治疗以手术为主的综合治疗,化疗可延缓肿瘤进展,TKIs、EML4-ALK融合基因抑制剂,对驱动基因阳性晚期PSC患者疗效确切,VEGF抑制剂恩度对晚期PSC疗效确切,阿帕替尼疗效可能欠佳。

Objective To investigate the clinical characteristics,diagnosis and treatment of pulmonary sarcomatoid carcinoma (PSC) and to improve cognition of the disease.Methods 21 patients with PSC were retrospectively reviewed on the clinical data,and their clinical characteristics,imaging,pathological features and therapeutic effect were analyzed.Results The clinical manifestations of PSC were similar to those of other types of lung cancer,and there were some differences in the imaging and pathological features.Among the 11 patients with relapsed and advanced PSC,there were 7 cases received chemotherapy alone,and 2 cases achieved PR,2 cases achieved SD and 3 cases achieved PD after 2 cycles of chemotherapy.The objective response rate (ORR) was 28.6%(2/7),the disease control rate (DCR) was 57.1%(4/7).They had a median of 10.5 months OS and 3.5 months PFS.2 cases with mutated EGFR gene in stage Ⅳ were treated by Gefitinib,1 case showed favourable effect and 1case for failed response.1 ALK-positive patient who was treated with crizotinib after 2 cycles of ineffective chemotherapy achieved remission of symptoms and tumor was stable for 4 months.Among the 4 cases in stage ⅢB-Ⅳ treated by Endostar combined with cisplatin-based chemotherapy,there were 2 cases of PR,1 case of SD and 1 case of PD.One patient at stage Ⅳ was ineffective after anti-angiogenesis therapy with Apatinib after 2 cycles of ineffective chemotherapy.Conclusion PSC is very rare,which has a short survival time and poor prognosis.There is no generally accepted standard treatment.Surgical therapy is the main treatment for PSC.The patient received chemotherapy may be feasible to delay the progression of tumor.Drive gene positive and advanced sarcomatoid carcinoma patients who are treated with TKIs and EML4-ALK fusion gene inhibitor show favourable effect.Advanced sarcomatoid carcinoma patients treated with Endostar show favourable effect,but it has poor efficacy after Apatinib.