复合型小细胞肺癌多学科诊疗及MRD探索1例

doi:10.11958/20251929

天津医药 ›› 2025, Vol. 53 ›› Issue (10): 1091-1097.doi: 10.11958/20251929

复合型小细胞肺癌多学科诊疗及MRD探索1例

刘畅¹(), 孟凡路¹^,^△(), 杨晶², 张荣新³, 汪俊萍⁴, 熊建华⁵, 钟殿胜¹

¹ 天津医科大学总医院肿瘤内科（邮编 300052）
² 天津医科大学总医院病理科（邮编 300052）
³ 天津医科大学总医院放射治疗科（邮编 300052）
⁴ 天津医科大学总医院医学影像科（邮编 300052）
⁵ 天津医科大学总医院神经外科（邮编 300052）

收稿日期:2025-05-16 修回日期:2025-06-30 出版日期:2025-10-15 发布日期:2025-10-12
通讯作者: ^△E-mail：mengfanlu1101@163.com
作者简介:刘畅（1989），女，主治医师，主要从事恶性实体瘤诊治及支持治疗相关研究。E-mail：1027259764@qq.com

A case study on multidisciplinary support in comprehensive diagnosis and treatment of combined small cell lung cancer and exploration of MRD

LIU Chang¹(), MENG Fanlu¹^,^△(), YANG Jing², ZHANG Rongxin³, WANG Junping⁴, XIONG Jianhua⁵, ZHONG Diansheng¹

¹ Department of Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
² Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, China
³ Department of Radiation Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
⁴ Department of Medical Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
⁵ Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China

Received:2025-05-16 Revised:2025-06-30 Published:2025-10-15 Online:2025-10-12
Contact: ^△E-mail：mengfanlu1101@163.com

刘畅, 孟凡路, 杨晶, 张荣新, 汪俊萍, 熊建华, 钟殿胜. 复合型小细胞肺癌多学科诊疗及MRD探索1例[J]. 天津医药, 2025, 53(10): 1091-1097.

LIU Chang, MENG Fanlu, YANG Jing, ZHANG Rongxin, WANG Junping, XIONG Jianhua, ZHONG Diansheng. A case study on multidisciplinary support in comprehensive diagnosis and treatment of combined small cell lung cancer and exploration of MRD[J]. Tianjin Medical Journal, 2025, 53(10): 1091-1097.

摘要/Abstract

摘要：

复合型小细胞肺癌（C-SCLC）在小细胞肺癌中约占20%，而混有鳞状细胞癌成分的C-SCLC占比仅不到3%，在病理学层面需要与其他类型的肺部肿瘤相鉴别，甚至依赖于分子检测手段进一步明确诊断。该文介绍了1例67岁初诊为周围型肺部肿瘤的患者经过外科手术、术后病理鉴别诊断、化疗、胸部放疗、脑放疗（脑转移）、脑放疗后动态随诊、脑手术等的多学科诊疗（MDT）过程，并在动态监测期间的关键时间点引入了分子残留病灶（MRD）检测，为患者的个体化治疗决策提供依据。前期MDT使得患者病情得到控制，总生存已超过30个月。通过对该例患者诊疗过程的介绍，以期为临床医生对复合型小细胞肺癌的诊治决策提供新的视角。

关键词: 组织学类型肿瘤, 化放疗, 肿瘤, 残余, 复合型小细胞肺癌, 脑转移, 多学科诊疗

Abstract:

Combined small cell lung cancer (C-SCLC) accounts for approximately 20% of all SCLC cases, while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%. At the pathological level, accurate diagnosis requires to distinguish it from other lung tumor types, and even rely on molecular testing. This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor. The patient underwent comprehensive multidisciplinary management, including surgical resection, postoperative pathological differential diagnosis, chemotherapy, thoracic radiotherapy, brain metastasis, cranial radiotherapy, dynamic follow-up of imaging changes after cranial radiotherapy, and cranial surgery. Molecular residual disease (MRD) monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions. The early MDT has brought the patient's condition under control, and the overall survival of the patient exceeded 30 months. Through the introduction of the diagnosis and treatment process of this patient, we aim to offer novel perspectives on clinical decision-making for C-SCLC.

Key words: neoplasms by histologic type, chemoradiotherapy, neoplasm, residual, combined small cell lung cancer, brain metastasis, multi-disciplinary treatment

中图分类号:

R734.2

图/表 5

图1 患者治疗前胸部CT影像 A：右肺下叶软组织结节；B：隆突下淋巴结肿大；C：两肺间质病变，间质纤维化。

Fig.1 Pre-treatment chest CT images of the patient

图2 患者术后病理镜下表现（×200） A：肺部病灶HE染色（黑色箭头所指为骤然出现的鳞状细胞癌巢团，部分呈角化珠）；B：肺部病灶Syn表达情况；C：肺部病灶P40表达情况；D：第7组淋巴结HE染色。

Fig.2 Postoperative pathological microscopic manifestations of the patient (×200)

图3 患者术后4个疗程化疗后放疗前胸部PET-CT影像

Fig.3 PET-CT chest imaging of the patient before radiotherapy and after 4 cycles of chemotherapy after operation

图4 胸部放疗后胸CT影像 A：2023-04-02胸部放疗结束后1周；B：2023-09-16胸部放疗结束后6个月，同期MRD阴性；C：2024-05-07胸部放疗结束后13个月，同期MRD阴性；D：2024-10-07胸部放疗结束后18个月，同期MRD阳性；E：2025-03-11胸部放疗结束后23个月，再次全身化疗前；第一行为肺窗，第二行为对应纵隔窗。

Fig.4 Chest CT findings after thoracic radiotherapy

图5 脑SRS前后头MRI影像变化 A：2023-07-26头双倍剂量MRI增强示左顶叶新发脑转移；B：2023-09-01（SRS后1个月）头双倍剂量MRI增强示同期MRD阴性；C：2023-12-19头双倍剂量MRI增强；D：2024-01-22颅脑平扫功能MRI；E：2024-03-25颅脑平扫功能MRI；F：2024-05-20第二程Bev输注后颅脑平扫功能MRI示同期MRD阴性；G：2024-06-21第三程Bev输注后颅脑平扫功能MRI；H：2024-06-21第三程Bev输注后头双倍剂量MRI增强；I：2024-10-08第四程Bev输注后头双倍剂量MRI增强；J：2024-10-14颅脑平扫功能MRI 动脉自旋标记（ASL）成像示左顶结节血流灌注较对侧略增加，同期MRD阳性。

Fig.5 Changes in cranial MRI findings before and after brain SRS

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复合型小细胞肺癌多学科诊疗及MRD探索1例

A case study on multidisciplinary support in comprehensive diagnosis and treatment of combined small cell lung cancer and exploration of MRD

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