病例报告：90基因表达检测指导的原发灶不明癌症部位特异性治疗：仑伐替尼联合卡瑞利珠单抗治疗隐匿性肾细胞癌

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中文摘要

背景： 原发灶不明癌症（CUP）主要采用经验性化疗，但临床结局仍不理想。我们报告一例62岁男性，表现为无症状左锁骨上淋巴结肿大。细针穿刺显示转移性低分化癌。包括增强计算机断层扫描（CT）、氟脱氧葡萄糖正电子发射断层扫描/CT（FDG-PET/CT）、鼻咽镜检查和胃镜检查在内的全面评估未能确定明确的原发肿瘤，导致诊断为CUP。初始经验性化疗采用脂质体紫杉醇和奈达铂，疗效有限，并出现3级治疗相关不良事件（TRAEs），因耐受性差而停药。随后，进行了空心针活检。免疫组织化学提示转移性肾细胞癌（RCC）。90基因表达检测确定肾脏为最可能的原发部位，相似性评分为82.6。随后将方案改为部位特异性治疗，使用仑伐替尼联合卡瑞利珠单抗。患者对治疗耐受良好，仅出现1级TRAEs。随访增强CT扫描显示病灶显著消退（2个月和4个月时分别缩小33.1%和69.6%），最佳疗效为部分缓解（PR）。结论：总之，仑伐替尼联合卡瑞利珠单抗在该患者中显示出良好的短期疗效和可接受的耐受性，肾样CUP代表一个独特的有利CUP亚型。

英文摘要

Cancer of unknown primary (CUP) is primarily treated with empirical chemotherapy, but clinical outcomes remain unsatisfactory. We present the case of a 62-year-old male with asymptomatic left supraclavicular lymphadenopathy. Fine-needle aspiration revealed metastatic poorly differentiated carcinoma. Comprehensive evaluation, including contrast-enhanced computed tomography (CT), fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT), nasopharyngoscopy, and gastroscopy, failed to identify a definite primary tumor, leading to a diagnosis of CUP. Initial empirical chemotherapy with liposomal paclitaxel and nedaplatin showed limited efficacy and was complicated by grade 3 treatment-related adverse events (TRAEs), resulting in discontinuation due to poor tolerability. Subsequently, a core needle biopsy was performed. Immunohistochemistry suggested metastatic renal cell carcinoma (RCC). A 90-gene expression assay identified the kidney as the most likely primary site, with a similarity score of 82.6. The regimen was then switched to site-specific therapy with lenvatinib plus camrelizumab. The patient tolerated treatment well, experiencing only grade 1 TRAEs. Follow-up contrast-enhanced CT scans demonstrated significant lesion regression (33.1% and 69.6% reductions at 2 and 4 months, respectively), achieving a best response of partial response (PR). In conclusion, the combination of lenvatinib and camrelizumab demonstrated a favorable short-term response and acceptable tolerability in this patient, and renal-like CUP represents a distinct favorable CUP subset.