免疫检查点抑制剂治疗致非小细胞肺癌向小细胞肺癌组织学转化：病例报道及文献复习

非小细胞肺癌（non-small cell lung cancer, NSCLC）作为肺癌的主要组织学亚型，在所有肺癌病例中约占85%。近年来，以程序性死亡受体1/配体1（programmed death 1/programmed death ligand 1, PD-1/PD-L1）抑制剂为代表的免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）在驱动基因阴性的NSCLC患者中取得了突破性进展，已被确立为一线治疗方案的重要组成部分并显著改善临床预后。然而，已有少量临床证据显示存在ICIs单药或联合治疗进展患者出现NSCLC向小细胞肺癌（small cell lung cancer, SCLC）组织学转化现象，而对于此类转化事件的临床特征、分子生物学基础及后续治疗策略目前仍缺乏系统性研究数据。本文报道了1例KRAS突变的肺腺癌患者经ICIs联合治疗16个月后发生SCLC转化的病例，并通过结合22例相似的文献病例进行了系统回顾。既往研究表明，小细胞转化是免疫治疗耐药的重要机制，转化后患者预后差。本文强调了治疗期间动态监测神经元特异性烯醇化酶（neuron-specific enolase, NSE）及规范二次活检的重要性，为临床实践提供了依据，有助于提高对这类少见的组织学转化的认知与应对能力，改善患者治疗效果。

• Publication year

  2025

• Venue

  Zhongguo fei ai za zhi = Chinese journal of lung cancer

• Publication date

  2025-07-20

• Fields of study

  Not labeled

• Identifiers
  DOI 10.3779/j.issn.1009-3419.2025.101.12PMID 40935646PMCID 12438652
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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