Department of Oncology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Department of Pathology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Ann Palliat Med. 2022 Mar;11(3):1147-1152. doi: 10.21037/apm-22-168.
Nasopharyngeal carcinoma (NPC) is a tumor caused by epithelial cells covering the surface of the nasopharynx. NPC only accounted for less than 1% of all cancers diagnosed worldwide. However, the global incidence rates are highest in southern China. We report a case of local advanced undifferentiated NPC [specifically, vesicular nucleus cell carcinoma (VNCC) of NPC]. Long-term disease-free survival (DFS) of a patient with stage IVA NPC is reported.
A 42-year-old male presented with a 4-month history of rhinorrhea and a lump in the left neck. The positron emission tomography (PET) showed local invasion to the surrounding tissues, specifically, the tumor invaded the brain. The pathological diagnosis was VNCC, the Epstein-Barr virus (EBV) was positive in tumor tissues by in situ hybridization. and the clinical diagnosis was stage IVA of NPC. The patient was treated with induction chemotherapy (IC) with gemcitabine and cisplatin (GP) followed by cisplatin/radiotherapy. The tumor lesions complete response (CR) after concurrent chemo-radiotherapy (CCRT).
To date, the DFS time has been more than 5 years. IC with GP followed by CCRT should be the first choice of treatment for patients with locoregionally advanced NPC. In recent years, more and more studies have shown the efficacy of immunotherapy in treating recurrent or metastatic NPC patients, especially in patients or are programmed death-ligand 1 (PD-L1)-positive or have a high tumor mutation burden. In the future, immunotherapy may become a standard treatment in clinic and bring longer survival to patients.
鼻咽癌（NPC）是一种发生于鼻咽部表面上皮细胞的肿瘤。NPC 仅占全球诊断出的所有癌症的不到 1%。然而，全球 NPC 的发病率在华南地区最高。我们报告了一例局部晚期未分化 NPC[具体为 NPC 的泡状核细胞癌（VNCC）]。报告了一例 IVA 期 NPC 患者的长期无病生存（DFS）。
一名 42 岁男性因流涕和左颈部肿块 4 个月就诊。正电子发射断层扫描（PET）显示局部侵犯周围组织，具体而言，肿瘤侵犯大脑。病理诊断为 VNCC，肿瘤组织中 EBV 通过原位杂交呈阳性，临床诊断为 NPC IVA 期。患者接受吉西他滨和顺铂（GP）诱导化疗（IC）后行顺铂/放疗。同期放化疗（CCRT）后肿瘤病变完全缓解（CR）。
迄今为止，DFS 时间已超过 5 年。对于局部晚期 NPC 患者，IC 联合 GP 后行 CCRT 应是首选治疗方法。近年来，越来越多的研究表明免疫疗法在治疗复发性或转移性 NPC 患者中的疗效，特别是在 PD-L1 阳性或肿瘤突变负担高的患者中。在未来，免疫疗法可能成为临床标准治疗方法，为患者带来更长的生存时间。
