Ito Miki, Watanabe Toru, Oga Yoko, Matsumoto Shigeki, Kimura Nana, Nagamori Masakazu, Tanaka Haruyoshi, Shibuya Kazuto, Yoshioka Isaku, Fujii Tsutomu
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Clin J Gastroenterol. 2025 Feb;18(1):208-213. doi: 10.1007/s12328-024-02043-5. Epub 2024 Oct 14.
A 72-year-old woman was diagnosed with unresectable pancreatic body-tail cancer (cT4N1M1, cStage IV) with para-aortic lymph node metastasis. She underwent six courses of gemcitabine + nab-paclitaxel as first-line chemotherapy, 12 courses of oxaliplatin + irinotecan + levofolinate + fluorouracil as second-line chemotherapy, and five courses of albumin-suspended irinotecan + levofolinate + fluorouracil as third-line chemotherapy. After each chemotherapy regimen, the disease was determined to be progressive. Analyses of endoscopic ultrasound-fine needle aspiration specimens and peripheral blood samples revealed microsatellite-instability (MSI)-high pancreatic cancer. The patient underwent 19 courses of pembrolizumab and achieved a partial response. She then underwent conversion surgery, including distal pancreatectomy, lymph node dissection, local gastrectomy and partial mesenteric resection of transverse colon. She is currently alive without recurrence at 18 months postoperatively. It is extremely rare for patients with unresectable and MSI-high pancreatic cancer to successfully undergo conversion surgery after pembrolizumab treatment.
一名72岁女性被诊断为不可切除的胰体尾癌（cT4N1M1，c期IV）伴主动脉旁淋巴结转移。她接受了六个疗程的吉西他滨+纳米白蛋白结合型紫杉醇作为一线化疗，十二个疗程的奥沙利铂+伊立替康+亚叶酸钙+氟尿嘧啶作为二线化疗，以及五个疗程的白蛋白结合型伊立替康+亚叶酸钙+氟尿嘧啶作为三线化疗。每次化疗方案后，疾病均被判定为进展。对内镜超声引导下细针穿刺标本和外周血样本的分析显示为微卫星高度不稳定（MSI-H）胰腺癌。该患者接受了19个疗程的帕博利珠单抗治疗并获得部分缓解。随后她接受了包括胰体尾切除术、淋巴结清扫术、局部胃切除术和横结肠部分肠系膜切除术在内的转化手术。她目前术后18个月仍存活且无复发。对于不可切除且MSI-H的胰腺癌患者，在接受帕博利珠单抗治疗后成功进行转化手术极为罕见。
