一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式

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一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式

刘芃昊, 王月坤, 连欣, 何家琳, 梁乃新, 李永强, 斯晓燕, 王汉萍, 张力, 有慧, 程欣, 张晓波, 赵大春, 马文斌, 王裕

文章导航 > 协和医学杂志 > 2021 > 12(4): 575-583

刘芃昊, 王月坤, 连欣, 何家琳, 梁乃新, 李永强, 斯晓燕, 王汉萍, 张力, 有慧, 程欣, 张晓波, 赵大春, 马文斌, 王裕. 一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式[J]. 协和医学杂志, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

引用本文:

刘芃昊, 王月坤, 连欣, 何家琳, 梁乃新, 李永强, 斯晓燕, 王汉萍, 张力, 有慧, 程欣, 张晓波, 赵大春, 马文斌, 王裕. 一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式[J]. 协和医学杂志, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

LIU Penghao, WANG Yuekun, LIAN Xin, HE Jialin, LIANG Naixin, LI Yongqiang, SI Xiaoyan, WANG Hanping, ZHANG Li, YOU Hui, CHENG Xin, ZHANG Xiaobo, ZHAO Dachun, MA Wenbin, WANG Yu. Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A 'Tailor-made' Pattern of Individualized Management[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

Citation:

LIU Penghao, WANG Yuekun, LIAN Xin, HE Jialin, LIANG Naixin, LI Yongqiang, SI Xiaoyan, WANG Hanping, ZHANG Li, YOU Hui, CHENG Xin, ZHANG Xiaobo, ZHAO Dachun, MA Wenbin, WANG Yu. Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A "Tailor-made" Pattern of Individualized Management[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

刘芃昊, 王月坤, 连欣, 何家琳, 梁乃新, 李永强, 斯晓燕, 王汉萍, 张力, 有慧, 程欣, 张晓波, 赵大春, 马文斌, 王裕. 一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式[J]. 协和医学杂志, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

引用本文:

刘芃昊, 王月坤, 连欣, 何家琳, 梁乃新, 李永强, 斯晓燕, 王汉萍, 张力, 有慧, 程欣, 张晓波, 赵大春, 马文斌, 王裕. 一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式[J]. 协和医学杂志, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

LIU Penghao, WANG Yuekun, LIAN Xin, HE Jialin, LIANG Naixin, LI Yongqiang, SI Xiaoyan, WANG Hanping, ZHANG Li, YOU Hui, CHENG Xin, ZHANG Xiaobo, ZHAO Dachun, MA Wenbin, WANG Yu. Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A 'Tailor-made' Pattern of Individualized Management[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

Citation:

LIU Penghao, WANG Yuekun, LIAN Xin, HE Jialin, LIANG Naixin, LI Yongqiang, SI Xiaoyan, WANG Hanping, ZHANG Li, YOU Hui, CHENG Xin, ZHANG Xiaobo, ZHAO Dachun, MA Wenbin, WANG Yu. Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A "Tailor-made" Pattern of Individualized Management[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 575-583. doi: 10.12290/xhyxzz.20200210

一例肾细胞癌脑转移患者的5次MDT：“量体裁衣”的个体化诊疗模式

doi: 10.12290/xhyxzz.20200210

刘芃昊¹,
王月坤¹,
连欣²,
何家琳²,
梁乃新³,
李永强⁴,
斯晓燕⁵,
王汉萍⁵,
张力⁵,
有慧⁶,
程欣⁷,
张晓波⁶,
赵大春⁸,
马文斌¹,
王裕^1, ,

1.
中国医学科学院北京协和医学院北京协和医院神经外科
2.
中国医学科学院北京协和医学院北京协和医院放疗科
3.
中国医学科学院北京协和医学院北京协和医院胸外科
4.
中国医学科学院北京协和医学院北京协和医院泌尿外科
5.
中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科
6.
中国医学科学院北京协和医学院北京协和医院放射科
7.
中国医学科学院北京协和医学院北京协和医院核医学科
8.
中国医学科学院北京协和医学院北京协和医院病理科

基金项目:

中央高校基本科研基金 3332018029

中国医学科学院医学科学创新基金 2016-I2M-2-001

清华大学-北京协和医院合作课题 2019ZLH101

通讯作者:
王裕电话：010-69152530，E-mail：ywang@pumch.cn

中图分类号: R737.11;R730.5
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- 文章访问数: 550
- HTML全文浏览量: 72
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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-05
- 录用日期: 2020-10-30
- 网络出版日期: 2021-06-07
- 刊出日期: 2021-07-30

Five Times of MDT for a Patient with Brain Metastases of Renal Cell Carcinoma: A "Tailor-made" Pattern of Individualized Management

1.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
3.
Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
4.
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
5.
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
6.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
7.
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
8.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds:

Fundamental Research Funds for the Central Universities 3332018029

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2016-I2M-2-001

Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program 2019ZLH101

More Information

Corresponding author: WANG Yu Tel: 86-10-69152530, E-mail: ywang@pumch.cn

摘要: 肾细胞癌是泌尿系统中恶性度较高的肿瘤，常出现远端转移，尤其伴随中枢神经系统转移后，患者预后更差，临床管理困难，需多学科协作诊疗。本文报道一例肾透明细胞癌多系统转移患者，经北京协和医院肿瘤多学科协作团队(multidisciplinary team，MDT)5次会诊，得到个体化诊疗，并取得良好效果。通过对MDT讨论决策进行详细分析，可展现MDT在疑难重症病例诊疗方面的优势，有助于缩短治疗时间窗、打破科室界限、提高患者依从性、更好地制定符合循证医学理念的诊疗建议，为患者提供更加精准、个体化的临床管理方案。
- 肾细胞癌 /
- 脑转移 /
- 肺转移 /
- 多学科协作团队 /
- 个体化诊疗
Abstract: Renal cell carcinoma(RCC) is a type of tumor with a high degree of malignancy in the urological system, often with distal metastases, especially to the central nervous system. These patients are often endowed with poorer prognosis and more complex management that require a multidisciplinary team(MDT). This article reported a case of clear cell renal cell carcinoma with multisystem metastases.The MDT of Peking Union Medical College Hospital(PUMCH) discussed and formulated the optimal individualized treatment scheme for the patient, and achieved good results after 5 consultations. Through a detailed analysis of discussions and decisions of MDT, the advantages in the treatment of such difficult and serious cases are demonstrated, including shortening the time window of treatment, breaking down departmental boundaries, improving patients' compliance, developing treatment recommendations in line with the concept of evidence-based medicine, and providing more accurate and individualized clinical managements for patients.
- renal cell carcinoma /
- brain metastases /
- lung metastases /
- multidisciplinary team /
- individualized management
注释:

作者贡献：刘芃昊负责文章撰写、修订及患者随访；王月坤负责案例收集、随访；连欣、何家琳、梁乃新、李永强、斯晓燕、王汉萍、张力，有慧，程欣，张晓波，赵大春，马文斌，王裕均为北京协和医院肿瘤MDT团队成员，负责患者的诊治策略及病情讨论，提供文章修改建议；王裕进行文章审核、修订。

利益冲突：无

图 1 患者手术前、后颅脑MRI影像学改变

A.2019年1月8日，颅脑MRI提示左顶叶不均匀强化占位，周围组织大片水肿；B.2019年1月17日，颅脑MRI提示左顶叶占位切除后改变，中线略向右移

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图 2 患者左顶叶占位术后病理组织形态符合肾细胞癌脑转移瘤

A.低倍镜(HE，×10)；B.高倍镜(HE，×40)

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图 3 患者右肺下叶病灶术后病理形态符合肾细胞癌肺转移瘤(HE，×10)

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图 4 患者阿西替尼治疗及放疗前、后颅脑MRI影像学改变

A.2019年5月7日，颅脑MRI显示残腔周围及右颞叶多发占位，内含出血成分，周围脑组织大片水肿；B.2019年11月4日，颅脑MRI显示左顶叶及右颞叶病灶获得显著改善，水肿范围明显减小

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图 5 患者的整体诊疗过程

橙色表示MDT诊疗经过；MDT：多学科协作团队；VATS：视频辅助胸腔镜手术

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参考文献(26)

[1]	NCCN. Clinical Practice Guidelines in Oncology. Central Nervous System Cancers. Version 2[EB/OL ]. [2020-09-16]. https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf.
[2]	NCCN. Clinical Practice Guidelines in Oncology. Kidney Cancer. Version 2[EB/OL ]. [2020-09-16]. https://www.nccn.org/professionals/physician_gls/pdf/kidney_blocks.pdf.
[3]	Gustafsson BI, Kidd M, Chan A, et al. Bronchopulmonary neuroendocrine tumors[J]. Cancer, 2008, 113: 5-21. doi: 10.1002/cncr.23542
[4]	王彦卿, 陈野野, 黄诚, 等. 肺类癌的诊治进展[J]. 协和医学杂志, 2021, 12: 366-372. doi: 10.3969/j.issn.1674-9081.2020.00.006 Wang YQ, Cheng YY, Huang C, et al. Progress in the Diagnosis and Treatment of Pulmonary Carcinoids[J]. Xiehe Yixue Zazhi, 2021, 12: 366-372. doi: 10.3969/j.issn.1674-9081.2020.00.006
[5]	Walts AE, Ines D, Marchevsky AM. Limited role of Ki-67 proliferative index in predicting overall short-term survival in patients with typical and atypical pulmonary carcinoid tumors[J]. Mod Pathol, 2012, 25: 1258-1264. doi: 10.1038/modpathol.2012.81
[6]	沈松杰, 韩志军, 于双妮, 等. 乳腺癌合并恶性肺结节: 乳腺癌肺转移? 还是乳腺和肺双原发癌?[J]. 协和医学杂志, 2019, 11: 109-114. doi: 10.3969/j.issn.1674-9081.20190116 Shen SJ, Han ZJ, Yu SN, et al. Breast cancer combined with malignant pulmonary nodules: pulmonary metastases from breast cancer? or breast and lung metastases?[J]. Xiehe Yixue Zazhi, 2019, 11: 109-114. doi: 10.3969/j.issn.1674-9081.20190116
[7]	Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2019, 30: 706-720. doi: 10.1093/annonc/mdz056
[8]	Noronha V, Joshi A, Bakshi G, et al. Current evidence and the evolving role of sunitinib in the management of renal cell carcinoma[J]. Indian J Cancer, 2016, 53: 102-108. doi: 10.4103/0019-509X.180824
[9]	Suarez-Sarmiento A Jr, Nguyen KA, Syed JS, et al. Brain Metastasis From Renal-Cell Carcinoma: An Institutional Study[J]. Clin Genitourin Cancer, 2019, 17: e1163-e1170. doi: 10.1016/j.clgc.2019.08.006
[10]	Bellesoeur A, Carton E, Alexandre J, et al. Axitinib in the treatment of renal cell carcinoma: design, development, and place in therapy[J]. Drug Des Devel Ther, 2017, 11: 2801-2811. doi: 10.2147/DDDT.S109640
[11]	Motzer RJ, Escudier B, Tomczak P, et al. Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial[J]. Lancet Oncol, 2013, 14: 552-562. doi: 10.1016/S1470-2045(13)70093-7
[12]	Kim YH, Kim JW, Chung HT, et al. Brain metastasis from renal cell carcinoma[J]. Prog Neurol Surg, 2012, 25: 163-175. doi: 10.1159/000331190
[13]	Fokas E, Henzel M, Hamm K, et al. Radiotherapy for brain metastases from renal cell cancer: should whole-brain radiotherapy be added to stereotactic radiosurgery?: analysis of 88 patients[J]. Strahlenther Onkol, 2010, 186: 210-217. doi: 10.1007/s00066-010-2055-z
[14]	Capitanio U, Bensalah K, Bex A, et al. Epidemiology of Renal Cell Carcinoma[J]. Eur Urol, 2019, 75: 74-84. doi: 10.1016/j.eururo.2018.08.036
[15]	Daugherty M, Daugherty E, Jacob J, et al. Renal cell carcinoma and brain metastasis: Questioning the dogma of role for cytoreductive nephrectomy[J]. Urol Oncol, 2019, 37: 182. e9-182. e15. doi: 10.1016/j.urolonc.2018.10.021
[16]	de Sousa VML, Carvalho L. Heterogeneity in Lung Cancer[J]. Pathobiology, 2018, 85: 96-107. doi: 10.1159/000487440
[17]	Sellner F. Isolated Pancreatic Metastases of Renal Cell Carcinoma-A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1, 034 Observations[J]. Front Oncol, 2020, 10: 709. doi: 10.3389/fonc.2020.00709
[18]	Turajlic S, Xu H, Litchfield K, et al. Tracking Cancer Evolution Reveals Constrained Routes to Metastases: TRACERx Renal[J]. Cell, 2018, 173: 581-594. e12. doi: 10.1016/j.cell.2018.03.057
[19]	Daboul N, Monga D, Bunker M. Primary renal carcinoid tumour with lung metastasis misdiagnosed as renal cell carcinoma[J]. BMJ Case Rep, 2016, 2016: bcr2015213432. http://www.ncbi.nlm.nih.gov/pubmed/26951438
[20]	Gill DM, Hahn AW, Hale P, et al. Overview of Current and Future First-Line Systemic Therapy for Metastatic Clear Cell Renal Cell Carcinoma[J]. Curr Treat Options Oncol, 2018, 19: 6. doi: 10.1007/s11864-018-0517-1
[21]	Heng DY, Xie W, Regan MM, et al. External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study[J]. Lancet Oncol, 2013, 14: 141-148. doi: 10.1016/S1470-2045(12)70559-4
[22]	Escudier B, Motzer RJ, Tannir NM, et al. Efficacy of Nivolumab plus Ipilimumab According to Number of IMDC Risk Factors in CheckMate 214[J]. Eur Urol, 2020, 77: 449-453. doi: 10.1016/j.eururo.2019.10.025
[23]	Lara P, Todd MB, Hamid O, et al. Epacadostat plus pembrolizumab in patients with advanced RCC: Preliminary phase Ⅰ/Ⅱ results from ECHO-202/KEYNOTE-037[J]. Clin Oncol, 2017, 35: 4515. http://www.researchgate.net/publication/345682256_Epacadostat_plus_pembrolizumab_in_patients_with_advanced_RCC_Preliminary_phase_III_results_from_ECHO-202KEYNOTE-037
[24]	Monteiro FSM, Soares A, Debiasi M, et al. First-line Treatment of Metastatic Renal Cell Carcinoma in the Immuno-oncology Era: Systematic Review and Network Meta-analysis[J]. Clin Genitourin Cancer, 2020, 18: 244-251. e4. http://www.sciencedirect.com/science/article/pii/S155876732030046X
[25]	Siam L, Bleckmann A, Chaung HN, et al. The metastatic infiltration at the metastasis/brain parenchyma-interface is very heterogeneous and has a significant impact on survival in a prospective study[J]. Oncotarget, 2015, 6: 29254-29267. doi: 10.18632/oncotarget.4201
[26]	Suh JH, Kotecha R, Chao ST, et al. Current approaches to the management of brain metastases[J]. Nat Rev Clin Oncol, 2020, 17: 279-299. http://www.nature.com/articles/s41571-019-0320-3

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