Assessment of Mrs. Li's condition
Pancreatic cancer is highly malignant, and the pathological types of patients are complex - "moderately-poorly differentiated", "adenosquamous carcinoma", and there are also "sarcomatoid" structures, posing a high risk of subsequent recurrence and metastasis.
The patient developed an accumulation of fluid in the abdominal and pelvic cavity after surgery. Although it decreased after adjuvant chemotherapy, it still persists and cannot be taken lightly.
The routine follow-up after chemotherapy indicated suspicious signals in the residual pancreas and right lobe of the liver. Considering the elevated tumor marker, the possibility of disease progression in the patient has increased.
NKT cell immunotherapy can delay the time of recurrence and metastasis, and currently represents the optimal time for patients to undergo treatment.
In December 2019, Mrs. Li underwent NKT cell therapy. Due to her high risk of recurrence and metastasis, an intensive regimen of two courses per month was adopted for treatment initially.
In July 2020, half a year later, the patient completed 8 courses of continuous systemic treatment. Through 3 follow-up visits and imaging examinations, no clear signs of tumor recurrence were found, and the tumor marker CEA decreased to normal values. indicates that the high risk of recurrence and metastasis has been suppressed.
Now that one year of treatment has passed, Mrs. Li, who has completed 15 courses, not only did not show clear signs of tumor recurrence or metastasis on imaging during the re examination in January 2021; The previously elevated CEA has returned to normal levels; The remaining CA125 and CA19-9 are within the normal range.
Science popularization tips
Many patients or their families feel nervous and anxious when they see an increase in tumor markers, which is completely unnecessary. The elevation of tumor markers can predict the trend of tumor development, but it does not strictly correspond. Fluctuations of up and down are also common situations. So a single increase or decrease cannot indicate a problem. Continuous monitoring can only determine whether the disease is progressing or improving if there is a trend of increase or decrease. Mrs. Li reported feeling more energetic than before. Immediately after her surgery, she required assistance to walk and her quality of life score was only 78 points. Now, after a year of treatment, her appetite has improved, and her quality of life has significantly increased - her quality of life score has reached 90.5 points, and she even rides a shared bicycle to and from her treatments.
Treatment Overview Analysis
>>On December 12, 2018, the patient underwent a CT scan of the abdominal and pelvic cavity, which revealed a low-attenuation mass with a rough margin in the pancreatic body, measuring approximately 2.9*1.8cm. The possibility of pancreatic body cancer with adjacent structural involvement was considered. >>On December 18, 2018, a pancreatic mass biopsy was performed. Pathology revealed poorly differentiated cancer infiltration. >>On April 9, 2019, the normal range of tumor markers was as follows: CEA 4.28ng/ml and CA19-9 <0.6U/ml. On May 6, 2019, laparoscopic exploration was performed under general anesthesia, followed by open radical resection of the pancreatic body and tail cancer. >>On May 17, 2019, the pathology report showed: ① (Resected specimens of pancreas, spleen, and left adrenal gland): Based on morphological and immunohistochemical results, the lesion was consistent with moderately-to-poorly differentiated adenosquamous carcinoma, with small foci presenting sarcomatoid structures and focal areas with significant fibrosis. No definite intravascular thrombus or neural invasion was observed, and no cancer was found at the pancreatic resection site. No definite metastasis was observed in the lymph nodes around the pancreas. No definite cancer involvement was found in the spleen and adrenal gland; ② (Resected end of hepatic artery nerve plexus) was examined and found to consist of fibrous adipose connective tissue and nerve fiber bundles, with no cancer observed; ③ (Resected end of celiac trunk mesenteric artery nerve plexus) was examined and found to consist of fibrous adipose connective tissue and nerve fiber bundles, with no cancer observed.
>>From June 25, 2019, to September 24, 2019, four cycles of adjuvant chemotherapy with gemcitabine and temozolomide were administered. On June 18, 2019, a follow-up abdominal CT scan showed: the resection site of the pancreatic body and tail and spleen, as well as the left adrenal gland, had undergone surgery; the fluid accumulation in the abdominal and pelvic cavity had decreased compared to previous scans.
>>On September 25, 2019, CT showed: 1. A few fibrous strands in both lungs; 2. Small nodules in the left lower lobe of the lung. On September 26, 2019, an upper abdominal MR plain scan showed: changes after resection of the pancreatic body and tail and spleen, as well as the left adrenal gland; suspicious abnormal signals in the residual pancreatic parenchyma, with no abnormal high signals on DWI; the abnormal signals in the right lobe of the original liver were similar to those observed previously (June 19, 2019). On September 3, 2019, tumor markers indicated: CEA 8.44ng/ml↑; on September 10, 2019, tumor markers indicated: CEA 6.74ng/ml↑.
>>Starting from December 10, 2019, NKT cell immunotherapy was administered, with a regimen of 2 courses per month. So far, 15 courses have been completed (as of January 7, 2021).
Abdominal MR: Pancreatic body and tail, spleen, left adrenal gland resection postoperative changes, punctate slightly long T2 signal shadow visible within the residual pancreatic parenchyma, size changes not significant from 2019-9 to 2020-1.
Abdominal CT: Compared to 2019-9 and 2020-1, the corresponding high signal area changes were not significant in 2020-6.
Abdominal CT: Compared to 2020-1, there were no significant changes in 2021-1.
AbdominalMR:Pancreatic body and tail, spleen, left adrenal gland resection postoperative changes, patchy slightly longT2signal shadow visible in the right lobe of the liver, size changes not significant from 2019-9to2020-1.
Abdominal CT: There was no significant change in size between 2020-6 and 2019-9 or 2020-1.
Abdominal CT: There was no significant change in size between 2021-1 and 2020-1 or 2020-6.
Abdominal CT: A high-density shadow was visible in the L3 vertebral body, with no significant change in size compared to the high-signal area shown in the corresponding abdominal MRI from 2019-9 and 2020-1. Abdominal CT: There was no significant change in the signal of the L3 vertebral body compared to previous scans. 
Abdominal CT: Mildly enlarged lymph nodes (1.2*0.8cm) were visible between the abdominal aorta and inferior vena cava, with no significant change in size between 2020-6 and 2019-9 or 2020-1. Abdominal CT 2021-1: Swollen lymph nodes were visible between the abdominal aorta and inferior vena cava, with no significant change compared to previous scans.
Lung CT: Small nodular shadow in the left lower lobe, with no significant change in size from September 2019 to January 2020, possibly due to vascular shadowing. Tumor marker detection analysis
Tumor marker: CEA increased in September 2019, returned to normal in January 2020, and slightly increased in May 2020; CA125 and CA19-9 are within the normal range, with attention to follow-up.
Review of classic NKT cases
Click on the image
to view
Popular science is a kind of charity
<<<Long press to recognize the QR code
Follow Tsinghua Cell Therapy
If you like, please click“Watch”now
