MSI-H的晚期残胃癌患者接受免疫治疗一例报道及文献复习

A Case Report and Literature Review of Patients with Advanced Residual Gastric Cancer with MSI-H Receiving Immunotherapy

胃癌(gastric cancer, GC)是世界范围内第五大常见恶性肿瘤,也是癌症相关死亡的第四大原因。目前,晚期胃癌的治疗方法主要是化疗和靶向治疗,免疫治疗也已成为胃癌的新治疗选择。2017年帕博利珠单抗被美国FDA批准用于PD-L1表达的局部晚期或转移性胃或胃食管结合部癌(gastric can-cer/gastroesophageal junction carcinoma, GC/GEJC)。此外,胃癌中高度微卫星不稳定(microsatellite instability-high, MSI-H)的患者更可能出现PD-L1过度表达,对于免疫治疗显示出更好的疗效。残胃癌(gastric stump cancer, GSC)是指胃术后残胃发生的癌,包括胃良性疾病术后5年以上残胃原发的癌及胃恶性肿瘤行胃切除术后10年以上,残胃出现的新发癌。对于不能手术切除的残胃癌,可参考胃癌的治疗方法。但对于残胃癌是否可以从免疫疗法中获益的临床证据有限。在本文中,回顾了一名MSI-H、体力状态较差的88岁男性晚期残胃癌患者在接受单药免疫治疗后,疗效达到部分缓解的过程,旨在分析总结病例,为今后该类患者的诊治提供借鉴。

Gastric cancer (GC) is the fifth most common malignant tumor worldwide and the fourth leading cause of cancer-related deaths. At present, chemotherapy and targeted therapy are the main treatment methods for advanced gastric cancer. Immunotherapy has also become a new treatment option for gastric cancer. In 2017, pembrolizumab was approved by the US FDA for use in locally advanced or metastatic gastric cancer or gastroesophageal junction carcinoma (GC/GEJC) expressing PD-L1. In addition, patients with highly microsatellite instability high (MSI-H) in gastric cancer are more likely to experience overexpression of PD-L1, which shows better efficacy in immunotherapy. Gastric stump cancer (GSC) refers to the cancer of the remnant stomach after gastric surgery, in-cluding the primary cancer of the remnant stomach more than 5 years after the operation of benign gastric diseases and the new cancer of the remnant stomach more than 10 years after gastrectomy of gastric malignancies. For residual gastric cancer that cannot be surgically removed, reference can be made to the treatment methods for gastric cancer. However, there is limited clinical evidence on whether residual gastric cancer can benefit from immunotherapy. In this article, a review was con-ducted on an 88-year-old male patient with MSI-H and poor physical condition who achieved partial remission after receiving monotherapy immunotherapy for advanced gastric cancer. The aim was to analyze and summarize the case and provide reference for the diagnosis and treatment of this type of patient in the future.