【摘要】 本文介绍1例原发性肺淋巴上皮瘤样癌(lymphoepithelioma-like carcinoma,LELC)的多学科团队(multidisciplinary team,MDT)诊疗过程。该患者经支气管活检病理诊断右肺LELC,结合影像学检查结果合并肝转移可能大,无驱动基因突变。第1次MDT讨论后行一线GP方案(吉西他滨+顺铂)化疗,2个周期后评估示肺内病灶部分缓解,肝内病灶未见缩小。第2次MDT讨论后,行CT引导下经皮穿刺肝内病灶未见肿瘤细胞,暂除外肝转移,肺病灶局限,遂行右肺癌根治术及淋巴结清扫术。术后6个月新发脑转移,第3次MDT讨论后行局部脑转移瘤切除术序贯全脑放疗。疾病稳定14个月后肝脏病灶进展,二线予免疫检查点抑制剂纳武利尤单抗单药免疫治疗,无进展生存期26个月。该晚期原发LELC患者至今总生存期达53个月。本例报道提示,经MDT讨论后行综合治疗,能确保患者获得更合适的治疗,以取得较长的疾病控制时间和长期的生存获益。更多还原

【Abstract】 This paper introduces the multidisciplinary team(MDT) diagnosis and treatment of a case of primary pulmonary lymphoepithelioma-like carcinoma(LELC). The patient was initially diagnosed with LELC of the right lung by bronchial biopsy pathology, with metastases in the liver, without driver gene mutation. After the first MDT discussion, the patient was treated with gemcitabine plus cisplatin(GP) regimen. The evaluation of this first-line therapy showed that the lung lesions were reduced, but the lesion in the liver showed no change. After the second MDT discussion, the patient underwent CT-guided puncture and no tumor cells were observed in the lesions of the liver. Therefore, radical resection of right lung cancer with lymph node dissection was performed. Half a year after surgery, new brain metastases occurred. After the third MDT discussion, the patient received local brain metastatic tumor resection and whole brain radiotherapy. After 14 months of stable disease, the liver lesion progressed, and the patient was treated with the second-line treatment with nivolumab. Presently, the patient had a progression-free survival of 26 months and overall survival beyond 53 months. The case suggested that combined treatment following MDT can ensure more appropriate treatment for patients to achieve a longer disease control time and long-term survival time.更多还原