腹腔热灌注化疗辅助替雷利珠单抗对进展期胃癌患者免疫功能、肿瘤标志物水平的影响  

Effect of HIPEC assisted tirelizumab on immune function and tumor marker levels in patients with advanced gastric cancer

作　　者：孙国辉 阿卜杜拉·阿卜迪艾尼 阿尔恒别克·吐尔拜 木拉提·库尔班 布麦热依木·依不热依木 Sun Guohui;Abudula Abudiaini;Aerhenbeike Tuerbai;Mulati Kuerban;Bumaireyimu Yibureyimn(Department of Oncology,Xinjiang Medical University Seventh Affiliated Hospital,Xinjiang Province,Urumqi 830000,China)

机构地区：[1]新疆医科大学第七附属医院肿瘤科,乌鲁木齐830000

出　　处：《疑难病杂志》2024年第6期641-645,652,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C312)。

摘　　要：目的探究腹腔热灌注化疗(HIPEC)辅助替雷利珠单抗对进展期胃癌患者临床疗效、免疫功能、肿瘤标志物、肿瘤侵袭相关指标、生存质量的影响。方法选取2022年1月—2023年2月新疆医科大学第七附属医院肿瘤科诊治进展期胃癌患者86例作为研究对象,随机数字表法分为常规化疗组(n=43)和联合治疗组(n=43)。常规化疗组给予常规FOLFOX化疗方案,联合治疗组在其基础上进行腹腔内HIPEC^(+)替雷利珠单抗注射治疗,连续治疗6个月。比较2组患者临床疗效、治疗前及治疗6个月后免疫功能(CD4^(+)T细胞比例、CD8^(+)T细胞比例、CD4^(+)/CD8^(+)比值)、胃癌相关肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]、肿瘤侵袭相关指标[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、基质金属蛋白酶-2(MMP-2)]的表达水平及生存质量[卡氏评分(KPS)]的差异。结果治疗6个月后,联合治疗组患者疾病控制率为69.77%,高于常规化疗组的46.51%(χ^(2)/P=3.842/0.050)。治疗6个月,联合治疗组患者CD4^(+)T细胞比例、CD4^(+)/CD8^(+)比值均高于常规化疗组,CD8^(+)T细胞比例低于常规化疗组(t/P=4.135/<0.001、2.980/0.004、3.864/<0.001);2组患者血清CEA、CA125、CA19-9水平均降低,且联合治疗组CEA、CA125水平低于常规化疗组(t/P=5.926/<0.001、2.961/0.004),而CA19-9水平差异无统计学意义(P>0.05);2组患者血清VEGF、bFGF、MMP-2水平均降低,且联合治疗组VEGF、MMP-2水平均低于常规化疗组(t/P=2.513/0.014、2.390/0.019),bFGF水平差异无统计学意义(P>0.05);治疗3、6个月2组患者平均KPS评分均依次升高,且联合治疗组高于常规化疗组(P<0.05)。结论相较于传统化疗方案,HIPEC化疗方法联合替雷利珠单抗能够更显著地改善进展期胃癌患者免疫功能,降低肿瘤标志物及肿瘤侵袭相关指标水平,提高患者临床疗效及生存质量,具有一定临床应用价值。Objective To investigate the effects of hyperthermic intraperitoneal chemotherapy(HIPEC)assisted with tirelizumab on immune function,tumor markers,tumor invasion-related indicators,quality of life and clinical efficacy in patients with advanced gastric cancer.Methods Eighty-six patients with advanced gastric cancer treated in the hospital from January 2022 to February 2023 were randomly divided into conventional chemotherapy group(n=43)and combination therapy group(n=43).Conventional chemotherapy group was given conventional FOLFOX chemotherapy regimen,and combination treatment group was given HIPEC chemotherapy regimen and intraperitoneal tirelizumab injection on the basis of FOLFOX chemotherapy regimen.The clinical efficacy,quality of life(KPS),expression levels of immune function(CD4^(+)T cell ratio,CD8^(+)T cell ratio,CD4^(+)/CD8^(+)ratio),tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 19-9(CA19-9)]and tumor invasion-related markers[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),matrix metalloproteinase-2(MMP-2)]were compared between the two groups before and 6 months after treatment.Results The DCR of combined chemotherapy group was 69.77%,significantly higher than that of conventional chemotherapy group(46.51%,χ^(2)/P=3.842/0.050).After 6 months of treatment,the CD4^(+)T cell ratio and CD4^(+)/CD8^(+)ratio in the combined therapy group were significantly higher than those in the conventional chemotherapy group,while the CD8^(+)T cell ratio was significantly lower than those in the conventional chemotherapy group(t/P=4.135/<0.001,2.980/0.004,3.864/<0.001).CEA and CA125 levels were significantly lower than those before treatment and in conventional chemotherapy group(t/P=5.926/<0.001,2.961/0.004),CA19-9 level had no significant difference between the two groups(P>0.05).The levels of VEGF,bFGF and MMP-2 decreased in both groups,and the average levels of VEGF and MMP-2 in the combined treatment group were lower than those in the c

关 键 词：胃癌 进展期 腹腔热灌注化疗 替雷利珠单抗 免疫功能 肿瘤标志物 

分 类 号：R735.2[医药卫生—肿瘤] R730.5[医药卫生—临床医学]