索凡替尼转化治疗胰腺神经内分泌肿瘤肝转移一例并文献复习  

Sulfatinib conversion therapy for liver metastasis of pancreatic neuroendocrine tumor:a case report and literature review

作　　者：陆思楠 苏同荣 张启逸 Lu Sinan;Su Tongrong;Zhang Qiyi(Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院肝胆胰外科,杭州310009

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期526-530,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：浙江省自然科学基金(LY22H160017);浙江省医药卫生科技计划项目(2020KY571)

摘　　要：目的探讨胰腺神经内分泌肿瘤(pNEN)转化治疗的临床指征、方法及预后。方法回顾性分析2021年1月浙江大学医学院附属第二医院收治的1例pNEN局部进展伴肝转移患者临床资料。患者男,49岁,因"体检发现肝脏占位20余天"入院。体检:皮肤、巩膜无黄染,腹平软,未及肿块。术前肿瘤标志物阴性。MRI示胰头部巨大肿瘤,大小约91 mm×49 mm×95 mm,病灶明显强化,肝Ⅳ段20 mm长径异常信号结节。穿刺活检病理示pNEN。诊断为pNEN局部进展伴肝转移。术前予索凡替尼300 mg每日口服治疗2个月。患者签署知情同意书,完善术前准备后,于2021年4月27日全身麻醉下行全胰切除联合脾脏切除+肝转移灶射频消融术。结果术前转化治疗2个月评估部分缓解(PR),原发灶和肝转移灶均明显缩小。术后病理示pNEN,G2级;免疫组化示CK(AE1/AE3)(+),Syn(+),CgA(+),Ki-6710%(+)。术后继续索凡替尼治疗,随访至术后10个月,肝脏增强MRI示肝内多发转移瘤。加用醋酸奥曲肽微球持续治疗2个月后评估为PR,随访至投稿前为无疾病状态。结论术前索凡替尼转化治疗pNENs局部进展伴肝转移有助于降期,提高手术切除完整率。对于术后肝转移复发的患者,索凡替尼联用醋酸奥曲肽微球可有效控制疾病进展,改善患者预后。Objective To investigate the clinical indications,methods and prognosis of conversion therapy for pancreatic neuroendocrine neoplasm(pNEN).Methods Clinical data of 1 pNEN patient with local progression complicated with liver metastasis admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in January 2021 were retrospectively analyzed.The 49-year-old male patient was admitted to hospital due to"a space-occupying liver lesion during physical examination for more than20 d".Physical examination showed no yellow coloration of the skin and sclera,the abdomen was flat and soft,and no mass was palpable.Preoperatively,tumor biomarkers were detected negative.MRI showed a huge tumor in the head of the pancreas,approximately 91 mm×49 mm×95 mm in size,the lesion was significantly enhanced,and a nodule with abnormal signal,with a maximal diameter of 20 mm,was detected in segmentⅣof the liver.Puncture biopsy prompted the diagnosis of pNEN.Finally,the diagnosis of pNEN with local progression complicated with liver metastasis was confirmed.Preoperatively,oral intake of sulfatinib ata dose of 300 mg was given daily for 2 months.After written informed consent was obtained from the patient and preoperative preparation was made,he underwent total pancreatectomy combined with splenectomy and radiofrequency ablation of liver metastasis under general anesthesia on April 27,2021.Results At2 months after preoperative conversion therapy,partial remission(PR)was evaluated,and primary lesion and liver metastasis were significantly mitigated.Postoperative pathological examination showed G2 pNEN.Immunohistochemistry showed CK(AE1/AE3)(+),Syn(+),CgA(+)and Ki-6710%(+).Sulfatinib treatment was further delivered after operation.During postoperative 10-month follow-up,enhanced MRI of the liver showed multiple metastases in the liver.PR was evaluated after continuous treatment with octreotide acetate-loaded microspheres for 2 months.The patient was found to be in a disease-free status until the paper submission.Con

关 键 词：胰腺神经内分泌肿瘤 肿瘤转移 靶向治疗 转化治疗 索凡替尼 酪氨酸激酶抑制剂(TKI) 醋酸奥曲肽 胰腺切除术 

分 类 号：R735.9[医药卫生—肿瘤]