Qin Ying-zhi, Chen Ye-ye, Bing Zhong-xing, Huang Cheng, Li Li, Liang Nai-xin, Liu Hong-sheng, Li Shan-qing
Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Meidical College, Beijing 100730, China.
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Zhonghua Wai Ke Za Zhi. 2013 Oct;51(10):900-3.
To analyze the clinical features, diagnosis and treatment of lung cancer associated paraneoplastic limbic encephalitis (PLE).
The clinical data of 7 cases of patients with lung cancer associated PLE out of 8927 patients of lung cancer from January 2000 to May 2010 was analyzed retrospectively. All the patients were male, aging from 41 to 54 years with a mean of 48 years. The data including history, physical examination, laboratory tests, diagnosis, treatment and follow-up were collected and analyzed.
All the 7 patients had smoking history. All 7 patients had varying short-term memory loss, 6 had epilepsy, 4 had different degrees of mental disorders, and 2 had syndrome of inappropriate secretion of antidiuretic hormone. Malignancies were screened and detected by chest X-ray or CT scan, while the pathological diagnoses were obtained through biopsy or transbronchial needle aspiration through electronic bronchoscope (5/7), biopsy of supraclavicular lymph nodes (1/7) and open pulmonary lobectomy (1/7). The pathological diagnosis included small cell lung cancer in 6 cases, adenocarcinoma of lung in 1 case. During the follow-up, 1 patient was lost, and the mean time of follow-up of the remaining 6 patients was about 11.5 months (ranged from 4 to 21 months). Four patients received early immunosuppressive treatment in terms of corticosteroids, only slight relief of neurological symptoms was seen in 2 patients. However, after chemotherapy (6/6), radiation (3/6), or surgical removal of the tumor (1/6), complete remission (3/6, with negative anti-Hu antibody) or partial remission (3/6, 2 of whom with positive anti-Hu antibody) of neurological symptoms were observed. Till October 2010, 3 patients with poorer tumor stag died ( survival were 4, 10, and 14 months respectively), while the other 3 patients with negative anti-Hu antibody and relative better tumor stag were still in the follow-up (the period were 5, 15, and 21 months).
PLE is a rare disease. In comparison with immunosuppressive therapy, chemotherapy, radiation or surgical removal of the tumor could provide better remission of the neurological symptoms. Positive serum anti-Hu antibody, poorer tumor stag, and together with poorer response to treatments seem to indicate a poorer prognosis.
分析肺癌相关性边缘叶脑炎（PLE）的临床特征、诊断及治疗方法。
回顾性分析2000年1月至2010年5月间8927例肺癌患者中7例肺癌相关性PLE患者的临床资料。所有患者均为男性，年龄41至54岁，平均48岁。收集并分析包括病史、体格检查、实验室检查、诊断、治疗及随访等数据。
7例患者均有吸烟史。7例患者均有不同程度的短期记忆力减退，6例有癫痫发作，4例有不同程度的精神障碍，2例有抗利尿激素分泌异常综合征。通过胸部X线或CT扫描筛查并发现恶性肿瘤，病理诊断通过活检或经电子支气管镜经支气管针吸活检（5/7）、锁骨上淋巴结活检（1/7）及开胸肺叶切除术（1/7）获得。病理诊断包括小细胞肺癌6例，肺腺癌1例。随访期间，1例患者失访，其余6例患者的平均随访时间约为11.5个月（4至21个月）。4例患者早期接受了皮质类固醇免疫抑制治疗，仅2例患者的神经症状略有缓解。然而，化疗（6/6）、放疗（3/6）或手术切除肿瘤（1/6）后，观察到神经症状完全缓解（3/6，抗Hu抗体阴性）或部分缓解（3/6，其中2例抗Hu抗体阳性）。至2010年10月，3例肿瘤分期较差的患者死亡（生存期分别为4、10和14个月），而其他3例抗Hu抗体阴性且肿瘤分期相对较好的患者仍在随访中（随访时间分别为5、15和21个月）。
PLE是一种罕见疾病。与免疫抑制治疗相比，化疗、放疗或手术切除肿瘤能更好地缓解神经症状。血清抗Hu抗体阳性、肿瘤分期较差以及对治疗反应较差似乎提示预后不良。
