治疗效果显著的1例AFP增高的原发性肺鳞癌病例报道

A Case Report of AFP-producing Primary Lung Squamous Cell Carcinoma with Significant Therapeutic Effect

背景与目的产生甲胎蛋白(alpha-fetoprotein,AFP)的原发性肺鳞癌很少见,迄今为止只有4例相关报道。AFP增高的具体原因和治疗产生AFP原发性肺鳞癌的有效方案目前还不清楚。现报告1例产生AFP的肺鳞癌诊断和治疗经过,为后续临床工作提供参考价值。方法回顾性分析山东省肿瘤医院2020年10月23日收治的1例AFP增高的原发性肺鳞癌患者的诊断、治疗过程并进行文献复习。结果患者男性,52岁,初始诊断:右肺上叶鳞癌T4N3M0、Ⅲc期纵隔淋巴结转移肺内多发转移。肿瘤标记物以血清异常增高的AFP为主。两线化疗快速进展后,三线予以安罗替尼+卡瑞丽珠单抗方案治疗,2个周期和4个周期后疗效评估分别为部分反应(partial response,PR)和病情稳定(stable disease,SD)。第5个周期治疗后因消化道出血更换为白蛋白紫杉醇+卡瑞丽珠单抗方案治疗,病情得到持续控制。结论案例报道中产生AFP的原发性肺鳞癌患者对安罗替尼联合免疫治疗反应良好,可为今后临床工作和研究AFP增高的原发性肺鳞癌带来指导意义。

Background and objective Primary lung squamous carcinoma that produces alpha-fetoprotein(AFP)is rare and only four related cases have been reported so far.The specific reasons for elevated serum level of AFP and effective treatment regimens for AFP-producing lung squamous carcinoma are not clear.This paper reports the diagnosis and treatment of AFP-producing lung squamous carcinoma so as to provide some references for similar cases in clinical practice.Methods The diagnosis and treatment of an AFP-producing lung squamous carcinoma patient admitted to the Shandong Cancer Hospital on October 23,2020 was retrospectively analyzed,and literatures were reviewed.Results A 52-year-old male patient was diagnosed as T4N3M0 stage,Ⅲc right upper lobe lung squamous cell carcinoma with mediastinal lymph node metastasis and multiple metastases in the lung.The main tumor marker was abnormally increased serum AFP.After the rapid progression of two lines chemotherapy,the patient was given anlotinib combined with carrizumab as third-line treatment.The efficacy evaluation reached to partial response(PR)and stable disease(SD)after 2 and 4 cycles of treatment,respectively.The treatment regimen was replaced with albumin paclitaxel plus carrizumab due to gastrointestinal bleeding after the fifth cycle.The patient’s condition was under continuous control.Conclusion The AFP-producing lung squamous carcinoma patient had a good response to anlotinib and immunotherapy in the case report,which may provide some guidances for the clinical practice and the research on AFP-producing lung squamous carcinoma.