中国肺癌杂志2025，Vol.28Issue(7)：558-566,9.DOI:10.3779/j.issn.1009-3419.2025.101.12
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
Histological Transformation from Non-small Cell Lung Cancer to Small Cell Lung Cancer Induced by Immune Checkpoint Inhibitor Therapy:A Case Report and Literature Review
摘要
Abstract
Non-small cell lung cancer(NSCLC),as the predominant histological subtype of lung cancer,ac-counts for approximately 85%of all lung cancer cases.In recent years,immune checkpoint inhibitors(ICIs),represented by programmed death 1/programmed death ligand 1(PD-1/PD-L1)inhibitors,have achieved breakthrough advancements in patients with driver gene-negative NSCLC.They have been established as a key component of first-line treatment regimens and have significantly improved clinical outcomes.However,limited clinical evidence has emerged showing the phenomenon of histological transformation from NSCLC to small cell lung cancer(SCLC)in patients experiencing disease progression after ICIs monotherapy or combination therapy.Systematic research data on the clinical characteristics,molecular biological basis,and subsequent treatment strategies for such transformation events are currently lacking.This article reports a case of SCLC transformation occurring in a patient with KRAS-mutated lung adenocarcinoma after 16 months of ICIs combination therapy and provides a systematic review of 22 similar published cases.The study demonstrates that small cell transformation is a criti-cal mechanism of immunotherapy resistance,and transformed patients exhibit poor prognosis.The research emphasizes the importance of dynamic monitoring of neuron-specific enolase(NSE)and standardized repeat biopsies during treatment,pro-viding a basis for clinical practice.This aids in enhancing the recognition and management capabilities for this rare histological transformation,ultimately improving patient outcomes.关键词
免疫检查点抑制剂/组织学转化/肺肿瘤Key words
Immune checkpoint inhibitors/Histological transformation/Lung neoplasms引用本文复制引用
陈曦婷,何文源,杨宁,熊丽娟,王浩强,刘鹏,谢波,周娟..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[J].中国肺癌杂志,2025,28(7):558-566,9.基金项目
本文受广东省基础与应用基础研究基金项目(No.2021A1515220040)和中国人民解放军南部战区总医院临床基础研究重点项目(No.2024NZB004)资助 This paper was supported by the grants from Guangdong Basic and Applied Basic Research Foundation,China(No.2021A1515220040)and the Key Project of Clinical Basic Research from the General Hospital of Southern Theater Com-mand of the Chinese PLA(No.2024NZB004) （No.2021A1515220040）
