背景:多原发恶性肿瘤(MPMNs)的患病率与恶性肿瘤的发病率同时增加,诊断模型的持续改进,延长肿瘤患者的寿命,尤其是那些消化系统。然而,MPMNs与十二指肠腺癌(DA)并存的报道很少.此外,缺乏关于多组学和肿瘤微环境(TME)的MPMNs的综合分析。
方法:在本文中,我们报告一例56岁的男性,主诉胸部不适和腹胀。患者在肿瘤科诊断为异时食管鳞状细胞癌和DA。他接受了食管肿瘤的根治性切除和化疗,以及化疗联合程序性死亡-1抑制剂治疗十二指肠肿瘤。总生存期为16.6mo。对原发性和转移性肿瘤的多组学和微环境特征进行了广泛评估,以:(1)确定在这种情况下导致不良预后和治疗耐药性的原因;(2)为MPMNs提供新的诊断和治疗方法。这种情况表明,第二种恶性肿瘤的发展可能与第一种肿瘤的位置无关。因此,为了准确诊断MPMNs,应将肿瘤复发(包括转移)与第二原发灶区分开来.
结论:多组学特征和TME可能有助于治疗选择,提高疗效,并辅助预测预后。
BACKGROUND: The prevalence of multiple primary malignant neoplasms (MPMNs) is increasing in parallel with the incidence of malignancies, the continual improvement of diagnostic models, and the extended life of patients with tumors, especially those of the digestive system. However, the co-existence of MPMNs and duodenal adenocarcinoma (DA) is rarely reported. In addition, there is a lack of comprehensive analysis of MPMNs regarding multi-omics and the tumor microenvironment (TME).
METHODS: In this article, we report the
case of a 56-year-old man who presented with a complaint of chest discomfort and abdominal distension. The patient was diagnosed with metachronous esophageal squamous cell carcinoma and DA in the Department of Oncology. He underwent radical resection and chemotherapy for the esophageal tumor, as well as chemotherapy combined with a programmed death-1 inhibitor for the duodenal tumor. The overall survival was 16.6 mo. Extensive evaluation of the multi-omics and microenvironment features of primary and metastatic tumors was conducted to: (1) Identify the reasons responsible for the poor prognosis and treatment resistance in this
case; and (2) Offer novel diagnostic and therapeutic approaches for MPMNs. This
case demonstrated that the development of a second malignancy may be independent of the location of the first tumor. Thus, tumor recurrence (including metastases) should be distinguished from the second primary for an accurate diagnosis of MPMNs.
CONCLUSIONS: Multi-omics characteristics and the TME may facilitate treatment selection, improve efficacy, and assist in the prediction of prognosis.