颊鳞状细胞癌超进展伴颈动脉窦综合征1例  

Hyperprogression of buccal squamous cell carcinoma accompanied by carotid sinus syndrome:A case report

作　　者：全玮旎 马进安[1] 赵夏琰 李云飞 吴元强[1] QUAN Weini;MA Jin’an;ZHAO Xiayan;LI Yunfei;WU Yuanqiang(Department of Oncology,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院肿瘤科,长沙410011

出　　处：《中南大学学报(医学版)》2024年第9期1531-1537,共7页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2020JJ6099)。

摘　　要：颊鳞状细胞癌(buccal squamous cell carcinoma,BSCC)是一种恶性程度高、复发率高、预后差、病死率高的口腔癌,多数患者确诊时已是局部晚期或已发生转移,需结合手术、放射治疗、化学治疗(以下简称“化疗”)、免疫治疗等综合治疗。超进展意味着肿瘤体积增大、增长速度加快、负荷增加,患者病情加重,是免疫治疗引起的严重不良后果。BSCC患者使用免疫治疗后发生超进展极少见,出现后可使用的挽救性治疗有限,患者生存受影响,预后极差。中南大学湘雅二医院2021年10月收治1例局部晚期BSCC患者,该患者经根治手术后快速复发并颈部淋巴结和双肺转移;在接受2个周期化疗联合免疫治疗后颊部原发灶、颈部淋巴结和双肺转移灶均明显增大,考虑为超进展;同时,频发以心动过缓、低血压和意识障碍为主要表现的颈动脉窦综合征,总生存4个月。探索超进展的原因和高风险因素,预防超进展的发生,是肿瘤免疫治疗时代的挑战。Buccal squamous cell carcinoma(BSCC)is a highly malignant oral cancer with high recurrence rates,poor prognosis,and significant mortality.Most patients are diagnosed at a locally advanced or metastatic stage,requiring a combination of treatments such as surgery,radiotherapy,chemotherapy,and immunotherapy.Hyperprogression refers to rapid tumor growth increased tumor burden,and worsening patient condition,representing a severe adverse effect of immunotherapy in BSCC is extremely rare,with limited salvage treatment options and poor prognosis.In October 2021,a locally advanced BSCC patient was treated at the Second Xiangya Hospital of Central South University.After undergoing radical surgery,the patient experienced rapid recurrence with cervical lymph node and bilateral lung metastases.Following two cycles of chemotherapy combined with immunotherapy,the primary buccal lesion,cervical lymph nodes,and pulmonary metastases significantly increased,indicative of hyperprogression.Concurrently,the patient developed carotid sinus syndrome,characterized by frequent bradycardia,hypotension,and altered consciousness,leading to an overall survival of 4 months.Understanding the causes and high-risk factors of hyperprogression and developing strategies for its prevention remain critical challenges in the era of cancer immunotherapy.

关 键 词：颊鳞状细胞癌 超进展 颈动脉窦综合征 免疫治疗 头颈鳞状细胞癌 

分 类 号：R739.91[医药卫生—肿瘤]