PD-1抑制剂联合化疗对进展期胃癌患者的近期疗效及相关因素分析  

Analysis of Short-term Efficacy and Related Factors of PD-1 Inhibitor Combined with Chemotherapy in Patients with Advanced Gastric Cancer

作　　者：蒋纪祥 陆斌[1] 张军峰[2] 徐乐 童瑞敏[1] JIANG Jixiang;LU Bin;ZHANG Junfeng;XU Le;TONG Ruimin(Yangzhong People's Hospital,Jiangsu Province,Yangzhong 212200,China)

机构地区：[1]江苏省扬中市人民医院,江苏扬中212200 [2]南京中医药大学医学院·整合医学学院

出　　处：《中国医学创新》2023年第18期5-9,共5页Medical Innovation of China

摘　　要：目的:探究程序性死亡受体1(PD-1)抑制剂联合化疗治疗进展期胃癌的近期效果及相关因素分析。方法:回顾性分析2020年5月-2022年2月扬中市人民医院治疗的130例进展期胃癌患者,依据实体瘤临床疗效评价标准(response evaluation criteria in solid tumour,RECIST)将患者分为有效组共(n=97)和无效组(n=33)。记录两组临床疗效,并比较两组不同性别、年龄、胆汁酸水平、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、肿瘤部位、分化程度、病理分期、PD-1抑制剂、化疗方案、肿瘤直径、TNM分期、程序性死亡受体配体1(PD-L1)表达,进一步logistic回归分析其影响因素。结果:130例进展期胃癌患者接受PD-1抑制剂联合化疗,达到完全缓解(CR)共7例(5.38%)、部分缓解(PR)共90例(69.23%)、疾病稳定(SD)共27例(20.77%)、疾病进展(PD)共6例(4.62%),总有效率为74.62%。两组性别、年龄、PLR、肿瘤部位、分化程度、病理分期、PD-1抑制剂、化疗方案比较,差异均无统计学意义(P>0.05);有效组肿瘤直径<6 cm、TNMⅡ期、PD-L1表达≥1%的占比均显著高于无效组,总胆汁酸水平与NLR≥3.7比例均显著低于无效组,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,肿瘤直径<6 cm、TNMⅡ期、PD-L1表达≥1%为临床疗效的保护因素,胆汁酸水平、NLR≥3.7为临床疗效的危险因素(P<0.05)。结论:PD-1抑制剂联合化疗治疗进展期胃癌的近期效果较好,肿瘤直径<6 cm、TNMⅡ期、PD-L1表达≥1%为临床疗效的保护因素,临床医师应据此寻找临床治疗进展期胃癌的合理方案。Objective:To investigate the short-term efficacy of programmed death-1(PD-1)inhibitor combined with chemotherapy in the treatment of advanced gastric cancer and analyze the related factors.Method:A total of 130 patients with advanced gastric cancer treated in Yangzhong People's Hospital from May 2020 to February 2022 were retrospectively analyzed.The patients were divided into effective group(n=97)and ineffective group(n=33)according to response evaluation criteria in solid tumour(RECIST).The clinical efficacy of the two groups were recorded,and the gender,age,bile acid level,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),tumor site,differentiation degree,pathological staging,PD-1 inhibitor,chemotherapy regimen,tumor diameter,TNM stage and programmed death-ligand 1(PD-L1)expression were compared between the two groups,and the influencing factors were further analyzed by logistic regression.Result:130 patients with advanced gastric cancer received PD-1 inhibitor combined with chemotherapy,and achieved complete response(CR)in 7 cases(5.38%),partial response(PR)in 90 cases(69.23%),stable disease(SD)in 27 cases(20.77%),and progressive disease(PD)in 6 cases(4.62%),with a total effective rate of 74.62%.There were no significant differences in gender,age,PLR,tumor site,differentiation degree,pathological staging,PD-1 inhibitor and chemotherapy regimen between the two groups(P>0.05).The proportions of tumor diameter<6 cm,TNMⅡstage and PD-L1 expression≥1%in the effective group were significantly higher than those in the ineffective group,and the bile acid level and the ratio of NLR≥3.7 were significantly lower than those in the ineffective group,the differences were statistically significant(P<0.05).logistic regression analysis showed that tumor diameter<6 cm,TNMⅡstage and PD-L1 expression≥1%Medical Innovation of China Vol.20,No.18 June,2023 were protective factors for clinical efficacy,and bile acid level and NLR≥3.7 were risk factors for clinical efficacy(P<0.05).Conclusion:PD-1 inhibitor co

关 键 词：胃癌 程序性死亡受体1抑制剂 化疗 近期疗效 相关因素 

分 类 号：R735.2[医药卫生—肿瘤]