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How can one manage to survive for 7 years with dual primary tumors in the liver and lung?

时间：2026-04-22　人气：

If you cannot understand the subsequent professional description, you can finish reading this text in two minutes

Disease Overview

Mr. Wang underwent a chest X-ray examination in early 2014 and discovered a shadow in the lower lobe of his right lung. Follow-up visits revealed an enlargement of the lesion, prompting further CT examination, which identified a small nodule at the hilum of the right lung, approximately 1.1 cm in diameter, with visible spicules. After multiple reexaminations, a tumor was suspected, and on September 3, 2014, a thoracoscopic resection of the lower lobe of the right lung was performed. Intraoperative frozen pathology revealed adenocarcinoma, T1N0M0, stage IA.

In 2015, Mr. Wang underwent an abdominal CT scan and discovered a liver lesion. On January 6, 2016, a follow-up examination revealed a liver lesion, suggesting liver cancer and cirrhosis. Further PET-CT examination confirmed liver cancer.

On January 13, 2016, an exploratory laparotomy, resection of a tumor in the right posterior segment of the liver, and resection of a nodule in the left lateral segment of the liver were performed. Postoperative pathology revealed cholangiocellular carcinoma in the right posterior segment of the liver, moderately differentiated, infiltrating perineural tissue, with visible vascular thrombi, T3NxMx; and adenomatoid hyperplasia nodules in the intrahepatic bile duct of the left lateral segment of the liver.

After surgery, Mr. Wang underwent two cycles of CIK immunotherapy in March and April 2016.

Department

Small

Knowledge

Recognition

Hepatocellular carcinoma

There are two common pathological types of primary liver cancer: hepatocellular carcinoma, which originates from liver cells, and cholangiocellular carcinoma, which originates from intrahepatic bile ducts. Hepatocellular carcinoma accounts for 90% of primary liver cancer cases, while cholangiocellular carcinoma is relatively rare but more prone to lymphatic metastasis.

Hepatocellular carcinoma often presents no early symptoms, and unlike hepatocellular carcinoma, the tumor marker AFP does not increase, making it difficult to detect in advance. Patients often present with symptoms at a later stage, leading to a poor prognosis. The prognosis for most patients with hepatocellular carcinoma is already poor, and cholangiocellular carcinoma is even more challenging to treat due to its biological characteristics.

Vascular tumor thrombus

Vascular tumor thrombus refers to the formation of tumor thrombi in blood vessels in resected tumor specimens, indicating tumor infiltration into blood vessels and the possibility that tumor cells have entered the circulatory system, traveling with the blood and increasing the likelihood of distant metastasis. It is an indicator of poor prognosis.

Mr. Wang was deeply concerned about the two primary tumors he had experienced. Despite undergoing surgery, he still faced the risk of metastasis and recurrence, and he was also worried about the possibility of developing new tumors. To reduce the risk of tumor recurrence and the emergence of new tumors, Mr. Wang reached out to Professor Zhang Minghui's NKT cell therapy team at Tsinghua University School of Medicine, hoping to slow down the progression of the tumor with the assistance of NKT therapy.

After reviewing Mr. Wang's medical records, Professor Zhang Minghui made the following analysis and judgment:

1. The patient has dual primary tumors. The lung cancer, which was discovered first, is at an early stage and carries a lower risk. The subsequently discovered hepatobiliary cancer is highly malignant, and postoperative pathology has revealed vascular cancer thrombus, indicating a higher risk.

2. Although the patient underwent radical surgery, he did not undergo chemotherapy due to resistance to it, and there is still a significant risk of metastasis and recurrence. The presence of two primary malignant tumors suggests that the patient may have a "tumor constitution".

3. NKT therapy utilizes powerful immune cells to eliminate tumor cells that may remain in the body but are otherwise undetectable, with essentially no side effects, making it very friendly to patients. The purpose of combining NKT cell therapy after radical surgery is to maintain long-term systemic stability.

Mr. Wang underwent NKT cell immunotherapy in May 2016 and has completed 48 courses to date (as of February 2023).

Professor Zhang Minghui analyzed Mr. Wang's condition: he achieved stability for a period of time after starting NKT treatment. Although metastasis to the abdominal lymph nodes was discovered in May 2018, it was not unexpected for a tumor with a high malignant potential like bile duct cancer. After undergoing cyber knife radiotherapy, the patient continued with NKT cell therapy and achieved long-term stability, demonstrating the effectiveness of the combined treatment approach.

During the treatment process, Mr. Wang experienced metastasis to the abdominal lymph nodes, which could not be removed surgically. However, after cyber knife intervention, he continued with NKT cell therapy, achieving long-term stability and improving his quality of life, thus meeting the expected goals.

Image aspect

Tumor markers

Tumor markers: AFP remained within the normal range during treatment; CA72-4 was within the normal range except in December 2016; CA19-9 was within the normal range except in March 2018 and February 2023, with the remaining values being above the normal range (41.6-74.7U/ml), requiring close observation; CEA was above normal (3.43-9.78) after August 2016, returned to normal after a recheck in May 2020 until March 2022, slightly above normal at 5.8U/ml in August 2022, and returned to normal in February 2023; CA153 was slightly above the normal range from October 2022 to March 2023, requiring recheck; CYFRA211 was slightly above normal on August 15, 2022, requiring recheck.

Conclusion and Comments

During this follow-up, Mr. Wang's overall condition has significantly improved compared to before. He reported good appetite and sleep, and his quality of life is excellent. His score this time is 88, which is higher than before (86).

Mr. Wang has dual primary malignant tumors. Two radical surgeries have caused significant physical and psychological harm to him. He has undergone NKT treatment for 80 months. Although lymph node metastasis occurred, he still achieved long-term stability under the combined treatment of CyberKnife and NKT cells. As of March 2023, it has been nearly 7 years, and Mr. Wang's overall condition remains stable with no new primary tumors appearing.

In a study on cholangiocarcinoma with vascular cancer thrombus, the authors compared hepatocellular carcinoma with portal vein tumor thrombus and cholangiocarcinoma with vascular cancer thrombus. Compared with hepatocellular carcinoma with portal vein tumor, cholangiocarcinoma with vascular cancer thrombus had poorer overall survival (OS) and higher tumor recurrence rate.

Mr. Wang's dual primary malignant tumors have recurred after surgery, and with a high degree of malignancy, NKT cell therapy intervention has stabilized Mr. Wang's condition. During this process, NKT cell immunotherapy plays an indispensable role in reducing the risk of recurrence and metastasis and strengthening the immune system, thereby providing patients with long-term stability.

Science popularization knowledge is for reference only. Individual patients should seek medical treatment based on clinical experience.

Reference:< H446>

【1】Feng JK, Sun JX, Liu ZH, Cheng SQ. Hepatocellular Carcinoma with Portal Vein Tumor Thrombus versus Hepatocellular Carcinoma with Biliary Tumor Thrombus: Better or Worse Prognoses? [Letter]. Cancer Manag Res. 2021; 13:987-988.

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