研究文章

胃癌伴类白细胞反应:一例罕见病例报告及文献综述

摘要

类白血病反应(LR)是非白血病状态下的显著白细胞增多,肿瘤相关LR常提示侵袭性较强。本文报道1例58岁男性胃癌患者,术前白细胞最高41.32×10⁹/L,以中性粒细胞增多为主,抗感染治疗无效。骨髓检查不支持白血病等血液病,PET-CT示胃体高代谢肿块,胃镜活检确诊中分化腺癌。患者行全腹腔镜全胃切除及D2淋巴结清扫,术后第8天白细胞恢复正常。病理分期pT3N0M0,HER2(3+)。术后接受SOX联合曲妥珠单抗治疗,随访1年余无复发转移。胃癌患者出现原因不明的显著中性粒细胞增多时,应在排除感染及克隆性血液病后考虑肿瘤相关LR;术后白细胞迅速下降可作为判断其来源及疗效的间接线索。

关键词

胃癌;类白血病反应;多学科协作;HER2

参考

Sakka V, Tsiodras S, Giamarellos-Bourboulis EJ, Giamarellou H: An update on the etiology and diagnostic evaluation of a leukemoid reaction. Eur J Intern Med 2006, 17(6):394-398.

Abukhiran I, Mott SL, Bellizzi AM , et al.: Paraneoplastic leukemoid reaction: Case report and review of the literature. Pathol Res Pract 2021, 217:153295.

Qing L, Xiang T, Guofu Z , et al: Leukemoid reaction in cervical cancer: a case report and review of the literature. BMC Cancer 2014, 14:670.

Hoshimoto S, Hoshi N, Ozawa I, et al.: Rapid progression of a granulocyte colony-stimulating factor-producing liver tumor metastasized from esophagogastric junction cancer: A case report and literature review. Oncol Lett 2018, 15(5):6475-6480.

Moro K, Nagahashi M, Naito T, et al.: Gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor: a case of a rare malignancy. Surg Case Rep 2017, 3(1):67.

Mukhopadhyay S, Mukhopadhyay S, Banki K, et al: Leukemoid reaction: a diagnostic clue in metastatic carcinoma mimicking classic Hodgkin lymphoma. Arch Pathol Lab Med 2004, 128(12):1445-1447.

Xiang YY, Deng CC, Liu HY,et al: The Prognostic Effect of Multidisciplinary Team Intervention in Patients with Advanced Gastric Cancer. Curr Oncol 2022, 29(2):1201-1212.

Demers M, Krause DS, Schatzberg D, et al: Cancers predispose neutrophils to release extracellular DNA traps that contribute to cancer-associated thrombosis. Proc Natl Acad Sci U S A 2012, 109(32):13076-13081.

Pezzella M, Quintarelli C, Quadraccia MC, et al: Tumor-derived G-CSF induces an immunosuppressive microenvironment in an osteosarcoma model, reducing response to CAR.GD2 T-cells. J Hematol Oncol 2024, 17(1):127.

He K, Liu X, Hoffman RD, et al: G-CSF/GM-CSF-induced hematopoietic dysregulation in the progression of solid tumors. FEBS Open Bio 2022, 12(7):1268-1285.

Abukhiran IA, Jasser J, Syrbu S: Paraneoplastic leukemoid reactions induced by cytokine-secreting tumours. J Clin Pathol 2020, 73(6):310-313.

Karagiannidis I, Salataj E, Said Abu Egal E,et al: G-CSF in tumors: Aggressiveness, tumor microenvironment and immune cell regulation. Cytokine 2021, 142:155479.

Azzam O, Hewavitharana CH, Fermoyle S, et al: Paraneoplastic leukemoid reaction in a localised squamous cell oesophageal cancer with paracrine G-CSF production. BMJ Case Rep 2020, 13(10).

Zhou C, Wang B, Teng C, et al: A phase Ia study of a novel anti-HER2 antibody-drug conjugate GQ1001 in patients with previously treated HER2 positive advanced solid tumors. J Transl Med 2025, 23(1):37.

Gravalos C, Jimeno A: HER2 in gastric cancer: a new prognostic factor and a novel therapeutic target. Ann Oncol 2008, 19(9):1523-1529.

Bang YJ, Van Cutsem E, Feyereislova A, et al: Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010, 376(9742):687-697.

Erdem O, Canbak T, Bacaksiz ME,et al: Trastuzumab significantly improves survival in resectable HER-2 positive gastric cancer: A retrospective study. Turk J Surg 2025, 41(1):85-91.

Refbacks

  • 当前没有refback。
版权所有(c)2026 斌 宋, 泽 金
Creative Commons License
此作品已接受知识共享署名-非商业性使用 4.0国际许可协议的许可。