PD-L1高表达伴EGFR与KRAS共突变晚期肺肉瘤样癌1例并文献复习

Advanced pulmonary sarcomatoid carcinoma with a high expression level of programmed death-ligand 1 and co-mutation of EGFR and KRAS:A case report and literature review

目的探讨程序性死亡配体-1(PD-L1)高表达伴表皮生长因子受体(EGFR)与Kirsten大鼠肉瘤病毒癌基因同源物(KRAS)共突变肺肉瘤样癌(PSC)的诊断和治疗。方法回顾性分析1例PD-L1高表达伴EGFR与KRAS共突变的晚期PSC病人,结合相关的文献复习,总结其诊治经过及治疗经验。结果病人经化疗、放疗、免疫治疗和靶向治疗等综合治疗,病情得到有效控制,总生存期已达29个月。结论晚期PSC具有显著的异质性,综合治疗可为病人带来更好的生存获益,而肿瘤组织的动态基因检测有助于指导治疗药物的选择。基于多重荧光免疫组织化学检测的肿瘤微环境分型对免疫治疗效果的预测作用有待进一步验证。

Objective To investigate the diagnosis and treatment of pulmonary sarcomatoid carcinoma(PSC)with a high expression level of programmed death-ligand 1(PD-L1)and co-mutation of epidermal growth factor receptor(EGFR)and Kirsten Rat Sarcoma Viral Oncogene Homolog(KRAS).Methods A retrospective analysis was performed for one patient with advanced PSC with a high expression level of PD-L1 and co-mutation of EGFR and KRAS,and a literature review was performed to summarize the diagnosis and treatment of the patient and related treatment experience.Results The condition of the patient was effectively controlled after multimodality therapy including chemotherapy,radiotherapy,immunotherapy,and targeted therapy,and the overall survival time had reached 29 months.Conclusion Advanced PSC has significant heterogeneity,and multimodality therapy can bring better survival benefits to patients.Dynamic gene detection of tumor tissue can guide the selection of therapeutic agents.Further studies are needed to verify the value of tumor microenvironment typing based on tumor multiple fluorescent immunohistochemical assay in predicting the efficacy of immunotherapy.