抗PD-1/PD-L1免疫疗法联合同步放化疗治疗局部晚期宫颈癌的临床效果  

Clinical effect of anti-PD-1/PD-L1 immunotherapy combined with concurrent radiotherapy and chemotherapy in the treatment of locally advanced cervical cancer

作　　者：邵莎莎[1] 曹丽艳[1] 王光霞[1] 付宝红[1] 付占昭[1] Shao Shasha;Cao Liyan;Wang Guangxia;Fu Baohong;Fu Zhanzhao(Department of Oncology,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院肿瘤科,秦皇岛066000

出　　处：《中国医师杂志》2022年第6期916-921,共6页Journal of Chinese Physician

摘　　要：目的探讨抗程序性死亡受体-1(PD-1)/程序性死亡配体-1(PD-L1)免疫疗法联合同步放化疗治疗局部晚期宫颈癌(LACC)的临床效果。方法回顾性选取2018年11月至2019年10月在秦皇岛市第一医院接受抗PD-1/PD-L1免疫疗法(帕博利珠单抗)联合同步放化疗[调强放疗(IMRT)+TP(紫杉醇+卡铂)化疗]治疗的LACC患者51例作为观察组,选取同期接受同步放化疗治疗的51例LACC患者作为对照组。比较两组客观缓解率、疾病控制率、肿瘤标志物[鳞状细胞癌抗原(SCCAg)、可溶性细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原125(CA125)]、增殖凋亡指标[存活素(Survivin)、B淋巴细胞瘤-2基因(Bcl-2)、半胱氨酸蛋白酶-3(Caspase-3)、细胞凋亡促进物质(Bax)]、PD-1/PD-L1[可溶性PD-L1(sPD-L1)、CD4^(+)T细胞表面PD-1表达(PD-1 CD4^(+)T细胞)、CD8^(+)T细胞表面PD-1表达(PD-1 CD8^(+)T细胞)及CD14^(+)单核细胞表面PD-L1表达(PD-L1 CD14^(+)单核细胞)]、安全性及1年内生存率。结果(1)疾病控制及安全性:观察组客观缓解率、疾病控制率分别为80.39%(41/51)、92.16%(47/51),高于对照组的39.22%(20/51)、70.59%(36/51)(均P<0.05),但组间各毒副反应发生率差异均无统计学意义(均P>0.05);(2)肿瘤标志物及增殖凋亡指标:与治疗前比较,治疗后两组血清SCCAg、CYFRA21-1、CEA、CA125水平及Survivin、Bcl-2水平均显著降低,Caspase-3、Bax水平显著升高,且治疗后观察组以上指标均优于对照组(均P<0.05);(3)PD-1/PD-L1:治疗后,观察组sPD-L1、PD-1 CD4^(+)T细胞、PD-1 CD8^(+)T细胞、PD-L1 CD14^(+)单核细胞较治疗前显著降低(均P<0.05),且观察组sPD-L1、PD-1 CD4^(+)T细胞、PD-1 CD8^(+)T细胞、PD-L1 CD14^(+)单核细胞均低于对照组(均P<0.05);(4)生存情况:观察组1年内生存率高于对照组(P<0.05)。结论抗PD-1/PD-L1免疫疗法联合同步放化疗治疗LACC临床效果显著,可通过调控肿瘤标志物、增殖凋亡指标及PD-1/PD-L1表达来有效抑制�Objective To investigate the clinical effect of programmed death receptor-1(PD-1)/programmed death receptor ligand-1(PD-L1)immunotherapy combined with concurrent radiotherapy and chemotherapy in the treatment of locally advanced cervical cancer(LACC).Methods From November 2018 to October 2019,51 LACC patients in Qinhuangdao First Hospital who received anti-PD-1/PD-L1 immunotherapy(pembrolizumab)combined with concurrent radiotherapy and chemotherapy[intensity modulated radiotherapy(IMRT)+TP(taxol+carboplatin)chemotherapy]were selected as the observation group.51 LACC patients who received concurrent chemotherapy and radiotherapy were selected as the control group.The objective remission rate,disease control rate,tumor markers[squamous cell carcinoma antigen(SCCAg),soluble cytokeratin 19 fragment(CYFRA21-1),and carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)],proliferation and apoptosis indicators[survivin(Survivin),B-cell lymphoma-2(Bcl-2),Caspase-3(Caspase-3),apoptosis-promoting substance(Bax)],PD-1/PD-L1[soluble PD-L1(sPD-L1),CD4^(+)T cell surface PD-1 expression(PD-1 CD4^(+)T cells),CD8^(+)T cell surface PD-1 expression(PD-1 CD8^(+)T cell)and CD14^(+)monocyte surface PD-L1 expression(PD-L1 CD14^(+)monocyte)],safety and survival rate within 1 year were compared between the two groups.Results(1)Disease control and safety:the objective response rate and disease control rate of the observation group were 80.39%(41/51)and 92.16%(47/51),respectively,which were higher than those of the control group by 39.22%(20/51)and 70.59%(36/51)(all P<0.05),but there was no significant difference in the incidence of side effects between the groups(all P>0.05).(2)Tumor markers and proliferation and apoptosis indexes:compared with those before treatment,the levels of serum SCCAg,CYFRA21-1,CEA,CA125,survivin and Bcl-2 in the two groups after treatment were significantly lower,and the levels of Caspase-3 and Bax were significantly higher;the above indexes in the observation group were better than those in the control gro

关 键 词：宫颈肿瘤 化放疗 免疫疗法 程序性细胞死亡受体1 生物标记 肿瘤 

分 类 号：R737.33[医药卫生—肿瘤]