University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology and Department of Molecular and Translational Medicine Section of Pathology, at Spedali Civili Hospital, Brescia, Italy.
University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology and Department of Molecular and Translational Medicine Section of Pathology, at Spedali Civili Hospital, Brescia, Italy.
Cancer Treat Rev. 2017 Sep;59:117-122. doi: 10.1016/j.ctrv.2017.07.007. Epub 2017 Jul 31.
Lung adenocarcinoma can transform to small-cell lung cancer (SCLC) when resistance to tyrosine kinase inhibitors (TKIs) develops. This phenomenon has repeatedly been described in several case reports and small patient series. The characteristics and treatment outcomes of this population, however, have not been comprehensively reported.
We performed a systematic review of the published literature to obtain explorative information on the clinical and pathological features and prognosis of the reported cases.
Twenty-five eligible publications were identified, contributing to 39 patients. The median time from initial diagnosis of lung adenocarcinoma to the transformation to SCLC (ttSCLC) was 19months (range 1-61months). The median survival after SCLC diagnosis was 6months. Female gender was significantly associated with longer ttSCLC at the multivariable analysis. Smoking status seemed to be associated with worse prognosis after the diagnosis of SCLC.
In this series of published cases, the transformation to a SCLC phenotype after an initial diagnosis of lung adenocarcinoma following TKI therapy appeared to be a late phenomenon. The prognosis after SCLC diagnosis is poor and current treatment strategies derived from primary SCLC seem to be largely inefficacious. New therapies are needed in the management of transformed SCLC.
肺腺癌在对酪氨酸激酶抑制剂（TKI）产生耐药性时可能会转化为小细胞肺癌（SCLC）。这种现象在几个病例报告和小系列病例中反复被描述。然而，该人群的特征和治疗结果尚未得到全面报道。
我们对已发表的文献进行了系统评价，以获取有关报告病例的临床和病理特征以及预后的探索性信息。
确定了 25 篇符合条件的出版物，为 39 名患者提供了资料。从初始肺腺癌诊断到小细胞肺癌转化（ttSCLC）的中位时间为 19 个月（范围 1-61 个月）。SCLC 诊断后中位生存时间为 6 个月。多变量分析显示，女性性别与 ttSCLC 时间延长显著相关。吸烟状态似乎与 SCLC 诊断后的预后较差相关。
在本系列已发表的病例中，TKI 治疗后初始诊断为肺腺癌后出现 SCLC 表型的转化似乎是一个晚期现象。SCLC 诊断后的预后较差，目前源自原发性 SCLC 的治疗策略似乎基本上无效。在管理转化型 SCLC 时需要新的治疗方法。
