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分子监测指导下的个性化多学科治疗使一名林奇综合征相关结直肠癌患者生存期延长:病例报告

Molecular surveillance-informed personalized multidisciplinary therapy achieves prolonged survival in a patient with Lynch syndrome-associated colorectal cancer: A case report.

作者信息

Xu Xin-Xin, Gao Yun-He, Du Cheng-Zhou, Gao Xiao-Xin, Chen Peng, Fan Rui-Fang, Li Hong-Tao, Qiao Zhi

机构信息

Department of General Surgery & Institute of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.

Department of General Surgery, The 940 Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China.

出版信息

World J Gastrointest Oncol. 2025 Jun 15;17(6):106316. doi: 10.4251/wjgo.v17.i6.106316.

DOI:10.4251/wjgo.v17.i6.106316
PMID:40547173
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12179925/
Abstract

BACKGROUND

Lynch syndrome (LS), an autosomal dominant genetic disorder, is distinguished by germline mutations in the DNA mismatch repair genes, including . These mutations confer an elevated risk for the development of colorectal cancer (CRC) and an array of other malignancies. Timely detection, facilitated by genetic profiling and stringent molecular surveillance, is crucial. It enables the implementation of customized therapeutic strategies, which have the potential to markedly enhance patient outcomes. Despite its significant public health impact, LS is frequently underdiagnosed, underscoring the necessity for increased vigilance and the adoption of precision medicine tactics.

CASE SUMMARY

This case presentation focuses on a 54-year-old male patient with a strong familial predisposition to colon cancer, who was identified to have LS-associated multiple colorectal neoplasms. Utilizing a comprehensive, multidisciplinary therapeutic strategy that encompassed precision medicine, immunotherapy with pembrolizumab, and stringent molecular residual disease monitoring, we effectively managed his advanced CRC. This tailored approach led to the achievement of sustained clinical remission exceeding 30 months, illustrating the promise of personalized treatment protocols in optimizing outcomes for individuals with LS and associated colorectal malignancies.

CONCLUSION

A synergistic, multidisciplinary approach is essential for managing LS-associated CRC, advocating for personalized care pathways in precision medicine.

摘要

背景

林奇综合征(LS)是一种常染色体显性遗传病,其特征是DNA错配修复基因发生种系突变,包括……。这些突变会增加患结直肠癌(CRC)和一系列其他恶性肿瘤的风险。通过基因分析和严格的分子监测实现及时检测至关重要。这使得能够实施定制的治疗策略,有可能显著改善患者的治疗效果。尽管LS对公共卫生有重大影响,但它经常被漏诊,这凸显了提高警惕和采用精准医学策略的必要性。

病例总结

本病例报告聚焦于一名54岁男性患者,他有很强的结肠癌家族易感性,被确诊患有与LS相关的多发性结直肠肿瘤。我们采用了一种综合的多学科治疗策略,包括精准医学、帕博利珠单抗免疫治疗以及严格的分子残留病监测,有效管理了他的晚期CRC。这种量身定制的方法实现了超过30个月的持续临床缓解,说明了个性化治疗方案在优化LS及相关结直肠恶性肿瘤患者治疗效果方面的前景。

结论

协同的多学科方法对于管理与LS相关的CRC至关重要,提倡在精准医学中采用个性化护理途径。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/988a0185bb08/wjgo-17-6-106316-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/28ec51c67fd0/wjgo-17-6-106316-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/7b1b0bb7dc7d/wjgo-17-6-106316-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/6846481d998f/wjgo-17-6-106316-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/988a0185bb08/wjgo-17-6-106316-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/28ec51c67fd0/wjgo-17-6-106316-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/7b1b0bb7dc7d/wjgo-17-6-106316-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/6846481d998f/wjgo-17-6-106316-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf2/12179925/988a0185bb08/wjgo-17-6-106316-g004.jpg

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本文引用的文献

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Multi-organ immune-related adverse events from immune checkpoint inhibitors and their downstream implications: a retrospective multicohort study.免疫检查点抑制剂引起的多器官免疫相关不良事件及其下游影响:一项回顾性多队列研究。
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林奇综合征遗传学及其临床意义。
Gastroenterology. 2023 Apr;164(5):783-799. doi: 10.1053/j.gastro.2022.08.058. Epub 2023 Jan 24.
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Immune Checkpoint Inhibitor-Based Strategies for Synergistic Cancer Therapy.免疫检查点抑制剂联合策略在癌症治疗中的协同作用。
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Lynch Syndrome-Associated Colorectal Cancer.林奇综合征相关结直肠癌
N Engl J Med. 2018 Aug 23;379(8):764-773. doi: 10.1056/NEJMcp1714533.
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DNA mismatch repair in cancer.癌症中的 DNA 错配修复。
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Recent progress in Lynch syndrome and other familial colorectal cancer syndromes.林奇综合征和其他家族性结直肠癌综合征的最新进展。
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Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with advanced colorectal carcinoma.抗程序性死亡蛋白-1(PD-1)抗体帕博利珠单抗在晚期结直肠癌患者中的安全性及抗肿瘤活性
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Microsatellite Instability as a Biomarker for PD-1 Blockade.微卫星不稳定性作为 PD-1 阻断的生物标志物。
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Milestones of Lynch syndrome: 1895-2015.林奇综合征的里程碑:1895-2015 年。
Nat Rev Cancer. 2015 Mar;15(3):181-94. doi: 10.1038/nrc3878. Epub 2015 Feb 12.