Stage IVの右下葉肺癌に対するpembrolizumab療法中に発生した右上葉肺癌に対し手術を施行した1例
63歳男性．3年前に多発脳転移や右副腎転移を伴う右下葉肺腺癌の診断で，脳腫瘍摘出術，全脳照射の後，pembrolizumab療法を開始した．1コース目に右上葉肺炎を発症し治療後に不整形のすりガラス陰影が残存した．9コース後，原発巣は0.6 cmへ縮小し転移巣は消失した．48コース後，右上葉肺炎後に残存したすりガラス陰影が急速に増大し，経気管支生検で右下葉肺癌と形態の異なる腺癌の所見が得られ，第二癌を疑った．右下葉肺癌に関しては免疫療法により部分奏効を維持しており，長期生存が得られる可能性を追求して右上葉肺癌に対し手術を施行した．初診時に腫大していた#12Lリンパ節が瘢痕様となり右上葉および肺動...
Saved in:
| Published in | 日本呼吸器外科学会雑誌 Vol. 37; no. 5; pp. 426 - 431 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本呼吸器外科学会
15.07.2023
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.37.426 |
Cover
| Abstract | 63歳男性．3年前に多発脳転移や右副腎転移を伴う右下葉肺腺癌の診断で，脳腫瘍摘出術，全脳照射の後，pembrolizumab療法を開始した．1コース目に右上葉肺炎を発症し治療後に不整形のすりガラス陰影が残存した．9コース後，原発巣は0.6 cmへ縮小し転移巣は消失した．48コース後，右上葉肺炎後に残存したすりガラス陰影が急速に増大し，経気管支生検で右下葉肺癌と形態の異なる腺癌の所見が得られ，第二癌を疑った．右下葉肺癌に関しては免疫療法により部分奏効を維持しており，長期生存が得られる可能性を追求して右上葉肺癌に対し手術を施行した．初診時に腫大していた#12Lリンパ節が瘢痕様となり右上葉および肺動脈に固着し剥離困難で，肺動脈に沿って同リンパ節を横断して右上葉を摘出した．5日目に一過性心房細動を認めたがその他の合併症は認めず10日目に退院した．病理結果で右上葉肺腺癌ypT1cN1MXと診断した． |
|---|---|
| AbstractList | 63歳男性．3年前に多発脳転移や右副腎転移を伴う右下葉肺腺癌の診断で，脳腫瘍摘出術，全脳照射の後，pembrolizumab療法を開始した．1コース目に右上葉肺炎を発症し治療後に不整形のすりガラス陰影が残存した．9コース後，原発巣は0.6 cmへ縮小し転移巣は消失した．48コース後，右上葉肺炎後に残存したすりガラス陰影が急速に増大し，経気管支生検で右下葉肺癌と形態の異なる腺癌の所見が得られ，第二癌を疑った．右下葉肺癌に関しては免疫療法により部分奏効を維持しており，長期生存が得られる可能性を追求して右上葉肺癌に対し手術を施行した．初診時に腫大していた#12Lリンパ節が瘢痕様となり右上葉および肺動脈に固着し剥離困難で，肺動脈に沿って同リンパ節を横断して右上葉を摘出した．5日目に一過性心房細動を認めたがその他の合併症は認めず10日目に退院した．病理結果で右上葉肺腺癌ypT1cN1MXと診断した． |
| Author | 川原, 洋一郎 諸星, 直輝 細川, 誉至雄 林, 浩三 田尾, 嘉浩 |
| Author_xml | – sequence: 1 fullname: 諸星, 直輝 organization: 勤医協中央病院呼吸器センター呼吸器外科 – sequence: 1 fullname: 川原, 洋一郎 organization: 勤医協中央病院呼吸器センター呼吸器外科 – sequence: 1 fullname: 田尾, 嘉浩 organization: 勤医協中央病院呼吸器センター呼吸器外科 – sequence: 1 fullname: 林, 浩三 organization: 勤医協中央病院呼吸器センター呼吸器外科 – sequence: 1 fullname: 細川, 誉至雄 organization: 勤医協札幌病院外科 |
| BookMark | eNplkEtrwkAUhYdioda67bp_IDYzk8kkS5E-BKGLPrZhkkxsxBeJLlq6SXY2QulTshLXpe3CjQj1z0RNfkZjlW66uffC-c6Fc3ZBptlqcgD2oVhAqkoOa8xwu061gGlBQvIWyEJFgYIEiZIBWVGFqiCqEtkBede1dVFECGEFy1lwd95hVX5Qvoq8z8XDeD4Jksde4k_jsB9574uvWeSFkR-0eUN3WnX7tttgehz6y_HrfPKREnE4jV-GkTeIvOGv__6ff7DsBcnoOfKflm_fyai_huF8FuyBbYvVXZ7f7By4PD66KJ0KlbOTcqlYEWpIolhQKYUWYZQRnetIldNLsgjmpm4S3aJYsgwiyaYiiymFJAVxmsajyDJ1kRAEcQ4U139r7iqt1nbsBnNuNOZ0bKPOtU15GqYaWY20wT_NuGZOCuAfgCaSlQ |
| ContentType | Journal Article |
| Copyright | 2023 特定非営利活動法人 日本呼吸器外科学会 |
| Copyright_xml | – notice: 2023 特定非営利活動法人 日本呼吸器外科学会 |
| DOI | 10.2995/jacsurg.37.426 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 1881-4158 |
| EndPage | 431 |
| ExternalDocumentID | article_jacsurg_37_5_37_426_article_char_ja |
| GroupedDBID | ABJNI ACGFS ALMA_UNASSIGNED_HOLDINGS JSF KQ8 OK1 RJT |
| ID | FETCH-LOGICAL-j2473-9771f5a7a5beb296a7a4f53edbd5bf734fc546d860f5a2482e722372fdb055213 |
| ISSN | 0919-0945 |
| IngestDate | Wed Sep 03 06:30:40 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 5 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j2473-9771f5a7a5beb296a7a4f53edbd5bf734fc546d860f5a2482e722372fdb055213 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jacsurg/37/5/37_426/_article/-char/ja |
| PageCount | 6 |
| ParticipantIDs | jstage_primary_article_jacsurg_37_5_37_426_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2023/07/15 |
| PublicationDateYYYYMMDD | 2023-07-15 |
| PublicationDate_xml | – month: 07 year: 2023 text: 2023/07/15 day: 15 |
| PublicationDecade | 2020 |
| PublicationTitle | 日本呼吸器外科学会雑誌 |
| PublicationTitleAlternate | 日呼外会誌 |
| PublicationYear | 2023 |
| Publisher | 一般社団法人 日本呼吸器外科学会 |
| Publisher_xml | – name: 一般社団法人 日本呼吸器外科学会 |
| References | 9. Takamochi K, Suzuki K, Sugimura H, Funai K, Mori H, Bashar AH, et al. Surgical resection after gefitinib treatment in patients with lung adenocarcinoma harboring epidermal growth factor receptor gene mutation. Lung Cancer 2007; 58: 149-55. 1. Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non-Small-Cell Lung Cancer with PD-L1 Tumor Proportion Score ≥ 50. J Clin Oncol 2021; 39: 2339-49. 6. Takamori S, Takenoyama M, Matsubara T, Fujishita T, Ito K, Yamaguchi M, et al. Cohesion between pulmonary artery and bronchus after immune checkpoint inhibitor therapy in a lung cancer patient. Thorac Cancer 2020; 11: 3605-8. 10. Lara-Guerra H, Waddell TK, Salvarrey MA, Joshua AM, Chung CT, Paul N, et al. Phase II study of preoperative gefitinib in clinical stage I non-small-cell lung cancer. J Clin Oncol 2009; 27: 6229-36. 5. Jiang L, Huang J, Jiang S, Rong W, Shen Y, Li C, et al. The surgical perspective in neoadjuvant immunotherapy for resectable non-small cell lung cancer. Cancer Immunol Immunother 2021; 70: 2313-21. 7. Bott MJ, Cools-Lartigue J, Tan KS, Dycoco J, Bains MS, Downey RJ, et al. Safety and Feasibility of Lung Resection After Immunotherapy for Metastatic or Unresectable Tumors. Ann Thorac Surg 2018; 106: 178-83. 8. Hashimoto K, Horinouchi H, Ohtsuka T, Kohno M, Izumi Y, Hayashi Y, et al. Salvage surgery for a super-responder by gefitinib therapy for advanced lung cancer. Gen Thorac Cardiovasc Surg 2012; 60: 851-4. 2. Forde PM, Chaft JE, Smith KN, Anagnostou V, Cottrell TR, Hellmann MD, et al. Neoadjuvant PD-1 blockade in resectable lung cancer. N Engl J Med 2018; 378: 1976-86. 14. Kennedy LB, Salama AKS. A review of cancer immunotherapy toxicity. CA Cancer J Clin 2020; 70: 86-104. 3. Jiang J, Wang Y, Gao Y, Sugimura H, Minervini F, Uchino J, et al. Neoadjuvant immunotherapy or chemoimmunotherapy in non-small cell lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2022; 11: 277-94. 12. Bott MJ, Yang SC, Park BJ, Adusumilli PS, Rusch VW, Isbell JM, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 158: 269-76. 13. Yang CJ, McSherry F, Mayne NR, Wang X, Berry MF, Tong B, et al. Surgical Outcomes After Neoadjuvant Chemotherapy and Ipilimumab for Non-Small Cell Lung Cancer. Ann Thorac Surg 2018; 105: 924-9. 4. El Husseini K, Piton N, De Marchi M, Grégoire A, Vion R, Blavier P, et al. Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case-Cohort Study. Cancers 2021; 13: 4915. 11. 石橋直也, 田畑俊治, 野々村遼, 大島 穣, 佐々木高信, 三友英紀, 他. 進行性肺癌に対する分子標的薬治療後のサルベージ手術の有効性と安全性について. 肺癌 2019; 59: 463-6. 15. Ryder M, Callahan M, Postow MA, Wolchok J, Fagin JA. Endocrine-related adverse events following ipilimumab in patients with advanced melanoma: a comprehensive retrospective review from a single institution. Endocr Relat Cancer 2014; 21: 371-81. |
| References_xml | – reference: 11. 石橋直也, 田畑俊治, 野々村遼, 大島 穣, 佐々木高信, 三友英紀, 他. 進行性肺癌に対する分子標的薬治療後のサルベージ手術の有効性と安全性について. 肺癌 2019; 59: 463-6. – reference: 3. Jiang J, Wang Y, Gao Y, Sugimura H, Minervini F, Uchino J, et al. Neoadjuvant immunotherapy or chemoimmunotherapy in non-small cell lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2022; 11: 277-94. – reference: 7. Bott MJ, Cools-Lartigue J, Tan KS, Dycoco J, Bains MS, Downey RJ, et al. Safety and Feasibility of Lung Resection After Immunotherapy for Metastatic or Unresectable Tumors. Ann Thorac Surg 2018; 106: 178-83. – reference: 4. El Husseini K, Piton N, De Marchi M, Grégoire A, Vion R, Blavier P, et al. Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case-Cohort Study. Cancers 2021; 13: 4915. – reference: 8. Hashimoto K, Horinouchi H, Ohtsuka T, Kohno M, Izumi Y, Hayashi Y, et al. Salvage surgery for a super-responder by gefitinib therapy for advanced lung cancer. Gen Thorac Cardiovasc Surg 2012; 60: 851-4. – reference: 10. Lara-Guerra H, Waddell TK, Salvarrey MA, Joshua AM, Chung CT, Paul N, et al. Phase II study of preoperative gefitinib in clinical stage I non-small-cell lung cancer. J Clin Oncol 2009; 27: 6229-36. – reference: 6. Takamori S, Takenoyama M, Matsubara T, Fujishita T, Ito K, Yamaguchi M, et al. Cohesion between pulmonary artery and bronchus after immune checkpoint inhibitor therapy in a lung cancer patient. Thorac Cancer 2020; 11: 3605-8. – reference: 14. Kennedy LB, Salama AKS. A review of cancer immunotherapy toxicity. CA Cancer J Clin 2020; 70: 86-104. – reference: 13. Yang CJ, McSherry F, Mayne NR, Wang X, Berry MF, Tong B, et al. Surgical Outcomes After Neoadjuvant Chemotherapy and Ipilimumab for Non-Small Cell Lung Cancer. Ann Thorac Surg 2018; 105: 924-9. – reference: 9. Takamochi K, Suzuki K, Sugimura H, Funai K, Mori H, Bashar AH, et al. Surgical resection after gefitinib treatment in patients with lung adenocarcinoma harboring epidermal growth factor receptor gene mutation. Lung Cancer 2007; 58: 149-55. – reference: 1. Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non-Small-Cell Lung Cancer with PD-L1 Tumor Proportion Score ≥ 50. J Clin Oncol 2021; 39: 2339-49. – reference: 5. Jiang L, Huang J, Jiang S, Rong W, Shen Y, Li C, et al. The surgical perspective in neoadjuvant immunotherapy for resectable non-small cell lung cancer. Cancer Immunol Immunother 2021; 70: 2313-21. – reference: 12. Bott MJ, Yang SC, Park BJ, Adusumilli PS, Rusch VW, Isbell JM, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 158: 269-76. – reference: 15. Ryder M, Callahan M, Postow MA, Wolchok J, Fagin JA. Endocrine-related adverse events following ipilimumab in patients with advanced melanoma: a comprehensive retrospective review from a single institution. Endocr Relat Cancer 2014; 21: 371-81. – reference: 2. Forde PM, Chaft JE, Smith KN, Anagnostou V, Cottrell TR, Hellmann MD, et al. Neoadjuvant PD-1 blockade in resectable lung cancer. N Engl J Med 2018; 378: 1976-86. |
| SSID | ssib002223836 ssib002809429 ssib006158315 ssib000936850 ssib005901879 ssj0061428 ssib050939265 ssib003115996 ssib023160720 ssib002484544 ssib058493845 ssib006554584 |
| Score | 2.3221505 |
| Snippet | 63歳男性．3年前に多発脳転移や右副腎転移を伴う右下葉肺腺癌の診断で，脳腫瘍摘出術，全脳照射の後，pembrolizumab療法を開始した．1コース目に右上葉肺炎を発症し治療後に不整形のすりガラス陰影が残存した．9コース後，原発巣は0.6... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 426 |
| SubjectTerms | 免疫チェックポイント阻害薬 異時性同側他肺葉肺癌 |
| Title | Stage IVの右下葉肺癌に対するpembrolizumab療法中に発生した右上葉肺癌に対し手術を施行した1例 |
| URI | https://www.jstage.jst.go.jp/article/jacsurg/37/5/37_426/_article/-char/ja |
| Volume | 37 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 日本呼吸器外科学会雑誌, 2023/07/15, Vol.37(5), pp.426-431 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrR1NaxNBdKn14kUUFb_pwTlJ6mZnZmfG226yoVUUhLb0FrIfEQqtpU0uxUtyqymInyWn0rNoD72Ugv0zaZv8DN-b3U0m1oOtQhgeM-9r3pvdfW8z89ayHoU1VyRc6rufKjCaJAXJ42JBJnZUp3EtjnQxnRcv3Zl59myRL05M7hm7lpqNcDra-OO5kot4FfrAr3hK9hyeHTKFDoDBv9CCh6H9Kx9DpAg5_-wCCShEhMQLSMCJrBCfkoARXxLpk0ASVSRSISAd4nskEEQpIks5lY9UHlAFWQ-MIuAA-WqyHOJ3fTaay7Uwp3RI4KIMxTMxXtngpXEyMYyoSs5U5EDljJbehbQUqAaQpJP0oIdmeiutoQIly9nQkI-hRlGLD4DejNA1pSAe10CJeCUUDMr5KWCjxggo4mnAYygJ1PUEomFPmXiuZl4iCmaiiPL1EKjigSr5ItcdvuYHoiRaBha8njn0MhxGDuURPic-DJa1AYMhvovIaIXUmjZKlDDJYESofeHbmoONk9aEHKWi0YEDqK1G-KBPgGbI-eNozl-Zb4ociq-g07Oy-to2tIBWavsJNJKvVyfMzKPj68eD3-P_bnbzHTSeoFNpPdHpJH0CS1ksQFQpzUd0WhcouxVx43nLHNcI3VgaUPweFUDExfXXKKL15trraSqmh2Rjldaz67iaIVapqHJsALuaj-FZSEC4ZF12hND7Qp6_MvIZhd9zMA-WQ0RMjfydScbNeFrC7I38BEtfKaP-JR4Ml8bf6JB-SGrE7y7H_72H_CBXc20xyv8gGYD0Z7SNAVAVlWz4fsDFcou6GGnmh7SqLdrrybi1ID5fWm8Md7rq4HvumnU1y5qnvNQ8162JpdoN662-_U3NLvRaP07e7x8fdAYfNgftw353q9f6drJ31Gt1e-3O2C2s322f7n85PvgOGP3uYf_zTq-13WvtaPp3Z-i3Tzc7g91PvfbH068_B7tbKXLx-Khz05qvBHOlmUL2MZnCksMELUCeW6zzmqjxMAkd5QLE6pwmcRjzsC4oq0ecubF0bcACPzmJAOcJpx6D3SDHobesyZU3K8lta6oY1RmTkQxhCTDqRCEH1tIRtZDasRuyO9bT1FjV1bRiUPUcK-vuvxDfs66MLvz71mRjrZk8gKSpET7UC_UXJj0oyw |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Stage+IV%E3%81%AE%E5%8F%B3%E4%B8%8B%E8%91%89%E8%82%BA%E7%99%8C%E3%81%AB%E5%AF%BE%E3%81%99%E3%82%8Bpembrolizumab%E7%99%82%E6%B3%95%E4%B8%AD%E3%81%AB%E7%99%BA%E7%94%9F%E3%81%97%E3%81%9F%E5%8F%B3%E4%B8%8A%E8%91%89%E8%82%BA%E7%99%8C%E3%81%AB%E5%AF%BE%E3%81%97%E6%89%8B%E8%A1%93%E3%82%92%E6%96%BD%E8%A1%8C%E3%81%97%E3%81%9F1%E4%BE%8B&rft.jtitle=%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A%E9%9B%91%E8%AA%8C&rft.au=%E8%AB%B8%E6%98%9F%2C+%E7%9B%B4%E8%BC%9D&rft.au=%E5%B7%9D%E5%8E%9F%2C+%E6%B4%8B%E4%B8%80%E9%83%8E&rft.au=%E7%94%B0%E5%B0%BE%2C+%E5%98%89%E6%B5%A9&rft.au=%E6%9E%97%2C+%E6%B5%A9%E4%B8%89&rft.date=2023-07-15&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A&rft.issn=0919-0945&rft.eissn=1881-4158&rft.volume=37&rft.issue=5&rft.spage=426&rft.epage=431&rft_id=info:doi/10.2995%2Fjacsurg.37.426&rft.externalDocID=article_jacsurg_37_5_37_426_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0919-0945&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0919-0945&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0919-0945&client=summon |