卡瑞利珠单抗联合nab-PC方案对晚期驱动基因阴性NSCLC的疗效及免疫功能的影响  

Efficacy of Camrelizumab combined with nab-PC regimen in the treatment of advanced driver gene-negative non-small cell lung cancer and its impact on peripheral blood Treg/Th17 imbalance and dendritic cell subpopulations

作　　者：马丹丹 吴圆圆 陈婧[1] 潘岩[1] 曹江威 郭超 李润浦 MA Dan-dan;WU Yuan-yuan;CHEN Jing;PAN Yan;CAO Jiang-wei;GUO Chao;LI Run-pu(Department of Oncology,Baoding Second Central Hospital,Baoding O72750,Hebei,China)

机构地区：[1]保定市第二中心医院肿瘤科,河北保定072750

出　　处：《广东医学》2024年第3期376-381,共6页Guangdong Medical Journal

基　　金：保定市科技计划自筹经费项目(2241ZF021)。

摘　　要：目的探讨卡瑞利珠单抗联合白蛋白结合型紫杉醇+卡铂方案(nab-PC方案)治疗晚期驱动基因阴性非小细胞肺癌(NSCLC)的临床疗效以及其对患者外周血调节性T细胞/辅助性T细胞17(Treg/Th17)失衡、树突状细胞亚群水平的影响。方法回顾性分析2020年6月至2022年6月收治的110例晚期驱动基因阴性NSCLC患者,按随机数字表法分成观察组和对照组,每组55例。对照组采用nab-PC方案治疗,观察组在对照组基础上联合卡瑞利珠单抗治疗。比较两组近期疗效。治疗前后检测两组试验对象血清肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、鳞状细胞癌抗原(SCC-Ag)]水平,外周血Treg、Th17表达水平,以及外周血树突状细胞亚群[髓样树突状细胞(mDC)、浆样树突状细胞(pDC)]水平。统计两组毒性不良反应发生情况。结果观察组客观缓解率(ORR)、疾病控制率(DCR)分别为45.45%、89.09%,对照组分别为27.27%、74.55%;观察组ORR、DCR均显著高于对照组(P<0.05)。治疗后,两组血清CEA、CYFRA21-1、SCC-Ag水平均较治疗前显著降低(P<0.05),均以观察组下降更显著(P<0.05)。治疗后,两组外周血Treg、Th17比例和Treg/Th17比值均较治疗前显著降低(P<0.05),均以观察组为著(P<0.05)。治疗后,两组外周血mDC比例、mDC/pDC比值均较治疗前显著升高(P<0.05),均以观察组上升更显著(P<0.05)。治疗后,观察组外周血pDC比例较治疗前显著降低(P<0.05);对照组治疗前后则无明显变化(P>0.05)。观察组皮肤毛细血管增生症发生率为63.64%,显著高于对照组(P<0.05)。两组其余各项毒性不良反应发生率比较差异无统计学意义(P>0.05)。结论卡瑞利珠单抗联合nab-PC方案治疗晚期驱动基因阴性NSCLC能有效调节外周血Treg/Th17失衡以及树突状细胞亚群水平,提高近期疗效。Objective To explore the clinical efficacy of camrelizumab combined with nab-PC regimen in the treatment of advanced driver gene-negative non-small cell lung cancer(NSCLC)and its impact on peripheral blood regulatory T cells/Helper T cells 17(Treg/Th17)imbalance and dendritic cell subpopulation levels in patients.Methods A retrospective analysis was conducted on l10 cases of advanced driver gene-negative NSCLC patients from June 2020 to June 2022.They were divided into two groups using a random number table,with each group consisting of 55 cases.The control group was treated with the nab-PC regimen,while the observation group received additional Cam-relizumab.Short-term efficacy was compared between the two groups.Serum tumor markers,including carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag),peripheral blood Treg,Th17 expression levels,and peripheral blood dendritic cell subpopulations[myeloid dendritic cells(mDC),plasmacytoid dendritic cells(pDC)]were measured before and after treatment.Adverse reactions were recorded for both groups.Results The objective response rate(ORR)and disease control rate(DCR)in the observation group were 45.45%and 89.09%,respectively,while in the control group,they were 27.27%and 74.55%.Both 0RR and DCR in the observation group were significantly higher than those in the control group(P<0.05).After treatment,the serum levels of CEA,CYFRA21-1,and SCC-Ag in both groups significantly decreased compared to before treatment(P<0.05),with a more significant reduction in the observation group(P<0.05).The proportions of peripheral blood Treg,Th17,and Treg/Th17 ratio in both groups significantly decreased after treatment(P<0.05),with a more pronounced reduction in the observation group(P<0.05).After treatment,the proportions of peripheral blood mDC and mDC/pDC ratio in both groups significantly increased(P<0.05),with a more significant increase in the observation group(P<0.05).After treatment,the proportion of peripheral blood

关 键 词：卡瑞利珠单抗 化疗 驱动基因阴性 非小细胞肺癌 树突状细胞亚群 调节性T细胞 辅助性T细胞17 

分 类 号：R734.2[医药卫生—肿瘤] R735.7[医药卫生—临床医学]