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具有高微卫星不稳定性和肿瘤突变负荷的肝内胆管癌对帕博利珠单抗有显著反应，但在短期内发生穿孔。

Intrahepatic Cholangiocarcinoma with High Microsatellite Instability and Tumor Mutation Burden That Responded Significantly to Pembrolizumab but Perforated within a Short Period.

作者信息

Yamazaki Shiori, Kubota Koji, Shimizu Akira, Notake Tsuyoshi, Umemura Kentaro, Kamachi Atsushi, Goto Takamune, Tomida Hidenori, Yamashita Naho, Sato Midori, Kanno Hiroyuki, Soejima Yuji

机构信息

Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Japan.

Department of Laboratory Medicine, Shinshu University School of Medicine, Japan.

出版信息

Intern Med. 2024 Apr 15;63(8):1105-1112. doi: 10.2169/internalmedicine.1492-22. Epub 2023 Sep 29.

DOI:10.2169/internalmedicine.1492-22
PMID:37779076
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11081885/
Abstract

Cholangiocarcinoma has a poor prognosis, and resection is the only curative treatment. Pembrolizumab, a programmed death receptor 1 inhibitor, has proven effective against unresectable or metastatic solid tumors with high microsatellite instability (MSI-H) or a high tumor mutation burden (TMB-H). In the present case, pembrolizumab treatment was initiated after standard chemotherapy for MSI-H and TMB-H unresectable intrahepatic cholangiocarcinoma. Intrahepatic tumor necrosis perforated the abdominal cavity. Emergency surgery was performed, but the patient died 36 days after admission. A pathological autopsy revealed that the intrahepatic tumor had almost completely disappeared.

摘要

胆管癌预后较差，手术切除是唯一的治愈性治疗方法。帕博利珠单抗是一种程序性死亡受体1抑制剂，已被证明对微卫星高度不稳定（MSI-H）或肿瘤突变负荷高（TMB-H）的不可切除或转移性实体瘤有效。在本病例中，对于MSI-H和TMB-H不可切除的肝内胆管癌，在标准化疗后开始使用帕博利珠单抗治疗。肝内肿瘤坏死穿破腹腔。进行了急诊手术，但患者在入院36天后死亡。病理尸检显示肝内肿瘤几乎完全消失。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/541c5369ce77/1349-7235-63-1105-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/1cb8f37a199c/1349-7235-63-1105-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/34008536f79c/1349-7235-63-1105-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/8ad1b1f4564c/1349-7235-63-1105-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/e2baca41cd90/1349-7235-63-1105-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/fbe4e0a67a6f/1349-7235-63-1105-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/541c5369ce77/1349-7235-63-1105-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/1cb8f37a199c/1349-7235-63-1105-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/34008536f79c/1349-7235-63-1105-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/8ad1b1f4564c/1349-7235-63-1105-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/e2baca41cd90/1349-7235-63-1105-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/fbe4e0a67a6f/1349-7235-63-1105-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3ad/11081885/541c5369ce77/1349-7235-63-1105-g006.jpg

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