1例晚期非小细胞肺癌的综合治疗

Comprehensive treatment of advanced non-small cell lung cancer: A case report

浙江衢化医院收治1例晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者,女,64岁,无明显诱因出现咳嗽,咳痰3个月余。胸部CT示:两肺多发浸润性灶,纵隔多发淋巴结肿大伴环形强化。腰椎MRI示:胸12椎体、腰1左侧椎弓、腰3/4椎体异常信号,考虑转移瘤。支气管镜病理示:(右肺中间支气管)腺癌。免疫组织化学示:CK7(+),CK14(-),TTF-1(+),p63(-),CEA(-),Ki-67(+++)45%,SPA(-),CK5/6(-)。EGFR基因检测示:Exon21突变。患者拒绝化学药物治疗,病情反复进展,经多次放射治疗及靶向治疗后,截至2019年5月31日,患者死亡,总生存期62个月。

A 64-year-old women with advanced non-small cell lung cancer was admitted to Zhejiang Quhua Hospital, after invalid treatments in a local hospital for no obvious cause of cough and sputum for more than 3 months. Chest CT showed multiple infiltrates in both lungs, mediastinal multiple lymphadenopathy with annular enhancement. Lumbar MRI examination revealed chest 12 vertebral body, lumbar 1 left vertebral arch, lumbar 3, 4 vertebral abnormal signals, considering metastases. Bronchoscopy pathology showed(right lung middle bronchus) adenocarcinoma. Immunohistochemistry revealed CK7(+), CK14(-), TTF-1+, p63(-), CEA(-), Ki-67(+++)45%, SPA(-), CK5/6(-). EGFR gene detection showed Exon21 mutation. The patient refused chemotherapy and progressed repeatedly. After multiple radiotherapy and targeted therapy, as of May 31, 2019, the patient died, with a total survival period of 62 months.