帕博利珠单抗联合培美曲塞、顺铂在食管鳞癌术前新辅助化疗中的效果及对SCCA、CEA、PD-1/PD-L1的影响  

Effectiveness of Pembrolizumab Combined with Pemetrexed and Cisplatin in Preoperative Neoadjuvant Chemotherapy of Esophageal Squamous Cell Carcinoma and Its Effects on SCCA,CEA,and PD-1/PD-L1

作　　者：陈婧[1] 高玉华[1] 马丹丹 吴圆圆 王艳丽[1] CHEN Jing;GAO Yu-hua;MA Dan-dan;WU Yuan-yuan;WANG Yan-li(Department of Oncology,the Second Central Hospital of Baoding City,Zhuozhou,Hebei 072750,China)

机构地区：[1]保定市第二中心医院肿瘤科,河北涿州072750

出　　处：《解放军医药杂志》2021年第7期23-27,31,共6页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省中医药管理局科研计划项目(2021414)。

摘　　要：目的探讨帕博利珠单抗联合培美曲塞、顺铂在食管鳞癌术前新辅助化疗中的应用效果,以及对鳞状上皮细胞癌抗原(SCCA)、癌胚抗原(CEA)、程序性死亡分子-1/程序性死亡分子-1配体(PD-1/PD-L1)的影响。方法选取2019年1月—2020年9月我院收治的98例食管鳞癌,根据治疗方法的不同分为研究组和对照组各49例。对照组予培美曲塞、顺铂术前新辅助化疗,研究组予帕博利珠单抗联合培美曲塞、顺铂术前新辅助化疗。比较2组近期疗效、手术切除率,化疗前、化疗后(术前)、术后3 d SCCA、CEA、细胞角蛋白19片段抗原21-1(CYFRA21-1)及血清可溶性PD-1(sPD-1)、可溶性PD-L1(sPD-L1)、sPD-1/sPD-L1水平,生活质量改善及不良反应情况。结果研究组疾病缓解率较对照组高(P<0.05)。2组手术总切除率比较差异无统计学意义(P>0.05),研究组R0切除率高于对照组(P<0.05)。2组化疗后(术前)、术后3 d血清SCCA、CEA、CYFRA21-1、sPD-1、sPD-L1水平均较化疗前明显下降,且研究组降幅高于对照组,差异有统计学意义(P<0.05,P<0.01)。研究组化疗后(术前)和术后3 d、对照组术后3 d血清sPD-1/sPD-L1水平较化疗前显著下降,且研究组化疗后(术前)、术后3 d血清sPD-1/sPD-L1水平低于对照组,差异有统计学意义(P<0.05,P<0.01)。研究组生存质量改善率高于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论食管鳞癌患者术前采用帕博利珠单抗联合培美曲塞、顺铂新辅助化疗,能显著提高疾病缓解率,下调血清SCCA、CEA、CYFRA21-1水平,抑制PD-1/PD-L1途径,提高手术效果,改善患者预后。Objective To investigate the application effectiveness of Pablizumab combined with Pemetrexed and Cisplatin in preoperative neoadjuvant chemotherapy of esophageal squamous cell carcinoma(ESCC),and to analyze its effects on squamous cell carcinoma antigen(SCCA),carcinoembryonic antigen(CEA)and programmed death molecule-1/programmed death molecule-1 ligand(PD-1/PD-L1).Methods A total of 98 patients with ESCC admitted between January 2019 and September 2020 were selected and divided into research group(n=49)and control group(n=49)according to different treatment methods.Control group was given Pemetrexed and Cisplatin preoperative neoadjuvant chemotherapy,while research group was given Pablizumab combined with Pemetrexed and Cisplatin preoperative neoadjuvant chemotherapy.Values of short-term efficacy,surgical resection rate,serum levels of SCCA,CEA and cytokeratin-19 fragment antigen21-1(CYFRA21-1),soluble PD-1(sPD-1),soluble PD-L1(sPD-L1)and sPD-1/sPD-L1 levels before chemotherapy,after chemotherapy(before operation)and after operation for 3 d,improvement of life quality and incidence rate of adverse reactions were compared between two groups.Results Remission rate in research group was significantly higher than that in control group(P<0.05).There was no significant difference in the total resection rate between two groups(P>0.05).The R0 resection rate in research group was significantly higher than that in control group(P<0.05).Serum levels of SCCA,CEA,CYFRA21-1,sPD-1 and sPD-L1 were significantly decreased after chemotherapy(before operation)and after operation for 3 d in two groups,and the decrease degrees in research group were significantly higher than those in control group(P<0.05,P<0.01).Serum levels of sPD-1/sPD-L1 after chemotherapy(before operation)and after operation for 3 d in research group and after operation for 3 d in control group were significantly lower than those before chemotherapy,and serum levels of sPD-1/sPD-L1 in research group were significantly lower than those in control group after che

关 键 词：食管肿瘤 帕博利珠单抗 培美曲塞 顺铂 鳞状上皮细胞癌抗原 程序性死亡分子-1/程序性死亡分子-1配体 

分 类 号：R735.1[医药卫生—肿瘤]