Sun Wei, Wang Xinlian, Shi Qifeng, Li Xiao, Chen Chaobo
Department of Respiratory and Critical Care Xishan People's Hospital of Wuxi City Wuxi China.
Department of Cardiothoracic Surgery Xishan People's Hospital of Wuxi City Wuxi China.
Clin Case Rep. 2023 May 18;11(5):e7365. doi: 10.1002/ccr3.7365. eCollection 2023 May.
In conclusion author highlights the tumor cell genetic testing or molecular pathological diagnosis plays a key role in the individualized treatment of PSC, which could benefit patients with advanced PSC.
An uncommon form of non-small-cell lung cancer (NSCLC) with a poor prognosis is pulmonary sarcomatoid carcinoma (PSC). Surgical resection is currently the preferred treatment, but guidelines for adjuvant chemotherapy have not yet been established, especially for the advanced stage. The development of molecular subgroups in the field of tumors may be advantageous to advanced PSC patients with the ongoing progress of genomics and immunology. A 54-year-old man presented to Xishan People's Hospital of Wuxi City with recurrent intermittent dry cough with fever for 1 month. Further examinations suggested the diagnosis of PSC occupying almost the entire right interlobar fissure area combined with malignant pleural effusion (Stage IVa). Pathological examination confirmed the diagnosis of PSC with overexpressing via genetic testing. However, after three cycles of chemo-, antiangiogenetic- and immunochemical therapy, the lesion was localized, and pleural effusion disappeared, the patient subsequently received an operation which was performed as R0 resection. Unfortunately, the patient became deteriorated quickly followed by extensive metastatic nodules in the thoracic cavity. Although the patient continued to receive chemo- and immunochemical-therapy, it did not limit the progress of the tumor, leading to widespread metastasis, and eventually died of multiple organ failure. For PSC patients with Stage IVa, chemo-, antiangiogenetic- and immunochemical-therapy performs well in clinical efficacy, and comprehensive panel-based genetic testing may offer PSC patients a somewhat better prognosis. However, blindly implementing surgical treatment may bring harm to the patient and affect long-term survival. It's essential to know the surgical indications precisely by NSCLC guidelines.
总之，作者强调肿瘤细胞基因检测或分子病理诊断在肺肉瘤样癌（PSC）个体化治疗中起关键作用，这可能使晚期PSC患者受益。
肺肉瘤样癌（PSC）是一种预后较差的非小细胞肺癌（NSCLC）罕见形式。手术切除目前是首选治疗方法，但辅助化疗指南尚未确立，尤其是对于晚期患者。随着基因组学和免疫学的不断发展，肿瘤领域分子亚组的研究可能对晚期PSC患者有利。一名54岁男性因反复间歇性干咳伴发热1个月就诊于无锡市锡山人民医院。进一步检查提示诊断为PSC，几乎占据整个右叶间裂区域并伴有恶性胸腔积液（IVa期）。病理检查通过基因检测确诊为PSC且有过表达。然而，经过三个周期的化疗、抗血管生成和免疫化学治疗后，病灶局限，胸腔积液消失，患者随后接受了手术，手术切除为R0切除。不幸的是，患者病情迅速恶化，随后胸腔内出现广泛转移结节。尽管患者继续接受化疗和免疫化学治疗，但仍未能限制肿瘤进展，导致广泛转移，最终死于多器官功能衰竭。对于IVa期的PSC患者，化疗、抗血管生成和免疫化学治疗在临床疗效方面表现良好，基于全面检测的基因检测可能为PSC患者提供稍好的预后。然而，盲目实施手术治疗可能会给患者带来伤害并影响长期生存。必须根据NSCLC指南准确了解手术指征。
