肺腺癌转化为小细胞肺癌的临床特征分析

Analysis of clinical features of lung adenocarcinoma transforming into small celllung cancer

目的分析肺腺癌转化为小细胞肺癌(SCLC)的临床特征,为诊治实践提供参考。方法回顾性分析7例肺腺癌转化为SCLC患者的临床特征、基因检测情况,采用电话、门诊随访的方式对7例患者进行随访,记录患者的疾病转归及预后情况。结果7例肺腺癌转化为SCLC的中位时间为16个月,转化后患者接受以依托泊苷+顺铂为主的化疗,并联合小分子靶向治疗、放疗、免疫检查点抑制剂等综合治疗。截至随访结束,1例患者生存,6例死亡,转化后患者的中位无进展生存期(PFS)为5个月;6例死亡患者的中位总生存期(OS)为11个月,2例患者免疫检查点抑制剂治疗后未见生存获益,2例化疗联合酪氨酸激酶抑制剂(TKI)治疗也未见生存获益。SCLC转化后部分患者胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)水平成倍升高。结论肺腺癌多线治疗后肿瘤进展且存在ProGRP、NSE成倍升高,需警惕向SCLC的转化。转化时间多需1年以上,转化前后的表皮生长因子受体(EGFR)突变类型大多保持一致,转化后使用TKI获益尚不明确。转化后的生物学行为与经典SCLC类似,大部分患者进展迅速,有效治疗手段少,缓解期短,预后更差。

Objective To analyze the clinical features of lung adenocarcinoma transformed into small cell lung cancer(SCLC),and provide reference for diagnosis and treatment practice.Method The clinical pathology and genetic testing of 7 patients with lung adenocarcinoma transformed into SCLC were analyzed retrospectively.They were followed up by telephone and outpatient follow-up,and the outcome and prognosis of the patients were recorded.Result The median time of SCLC transformation from lung adenocarcinoma following treatment was 16 months.After transformation,the patients received etoposide+cisplatin chemotherapy,combined with small molecule targeted therapy,radiotherapy,immune checkpoint inhibitors and other comprehensive treatment.By the end of follow-up,1 patient survived,6 patients died,and the median progression free survival(PFS)was 5 months;the median overall survival(OS)of 6 patients died was 11 months,2 patients had no survival benefit after immune checkpoint inhibitor treatment,and 2 patients had no survival benefit after chemotherapy combined with tyrosine kinase inhibitor(TKI)treatment.The levels of pro-gastrin-releasing peptid(ProGRP)and neuron specific enolase(NSE)increased in some cases after the transformation to SCLC.Conclusion After multi-line treatment of lung adenocarcinoma,the tumor progresses and there is a double increase of ProGRP and NSE,it is necessary to be alert to the conversion to SCLC.The transformation time takes more than 1 year,the mutation types of epidermal growth factor receptor(EGFR)before and after transformation are mostly the same.The benefit of using TKI after transformation is still unclear.The biological behavior after transformation is similar to that of classic SCLC,most patients progress rapidly,have fewer effective treatments,have a short remission period,and have a worse prognosis.