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病例报告:卡瑞利珠单抗联合阿昔替尼治疗Xp11.2易位/TFE3基因融合相关晚期肾细胞癌的临床完全缓解:一例罕见病例报告

Case Report: Clinical complete response of advanced renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion by treated by camrelizumab and axitinib: A rare case report.

作者信息

Zhao Juping, Dai Kun, Xie Jialing, Fang Chen, Chen Na, Dai Jun, Xu Danfeng

机构信息

Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Hangzhou Jichenjunchuang Medical Laboratory Co.Ltd, Hangzhou, China.

出版信息

Front Pharmacol. 2022 Aug 11;13:927299. doi: 10.3389/fphar.2022.927299. eCollection 2022.

Abstract

Renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusions is a rare subtype of renal tumor. This entity predominantly occurs in juveniles, but rarely in adults. Xp11.2 translocation RCC (tRCC) patients with lymph node or organ metastasis are associated with poor prognosis, and the strategy remains controversial. Herein, we presented our experience with the diagnosis and treatment of an adult case of Xp11.2 tRCC. In our clinical practice, a 32-year-old male manifested fever and right flank paroxysmal blunt pain, and computed tomography showed an inhomogeneous mass, 6 cm in diameter, in the right kidney. Then right partial nephrectomy (PN) and renal hilar lymph node dissection by laparoscopic surgery were performed. Pathology revealed that the tumor cells were positive for TFE3 immunohistologically and positive for TFE3 break-apart fluorescence hybridization assay. A splice site mutation c.1544-1G>T of protein tyrosine phosphatase receptor delta () was detected by next-generation sequencing and weak PTPRD expression was confirmed in tumor tissues compared to tumor periphery. This patient was diagnosed with stage III RCC and received immune checkpoint inhibitor (camrelizumab) in combination with tyrosine kinase inhibitor (axitinib) treatment for 1 year. He achieved a clinical complete response with no sign of recurrence or metastasis. mutation might be a favorable indicator for Xp11.2 tRCC patients managed by PN and followed by the adjuvant therapy of immune checkpoint inhibitor and tyrosine kinase inhibitor.

摘要

与Xp11.2易位/TFE3基因融合相关的肾细胞癌(RCC)是一种罕见的肾肿瘤亚型。该实体主要发生于青少年,但在成人中罕见。伴有淋巴结或器官转移的Xp11.2易位性肾细胞癌(tRCC)患者预后较差,治疗策略仍存在争议。在此,我们介绍了一例成人Xp11.2 tRCC的诊断和治疗经验。在我们的临床实践中,一名32岁男性表现为发热和右腰腹部阵发性钝痛,计算机断层扫描显示右肾有一个直径6厘米的不均匀肿块。随后通过腹腔镜手术进行了右肾部分切除术(PN)和肾门淋巴结清扫术。病理显示肿瘤细胞TFE3免疫组化阳性,TFE3断裂荧光原位杂交检测阳性。通过下一代测序检测到蛋白酪氨酸磷酸酶受体δ(PTPRD)的剪接位点突变c.1544-1G>T,与肿瘤周边相比,肿瘤组织中PTPRD表达较弱。该患者被诊断为III期RCC,并接受了免疫检查点抑制剂(卡瑞利珠单抗)联合酪氨酸激酶抑制剂(阿昔替尼)治疗1年。他实现了临床完全缓解,无复发或转移迹象。PTPRD突变可能是接受PN治疗并随后接受免疫检查点抑制剂和酪氨酸激酶抑制剂辅助治疗的Xp11.2 tRCC患者的一个有利指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a966/9403306/9dbf58dcbe8c/fphar-13-927299-g001.jpg

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