晚期食管鳞癌患者接受免疫检查点抑制剂治疗的疗效及预后影响因素分析  

Therapeutic efficacy and prognostic factors in advanced esophageal squamous cell carcinoma patients on a therapy of immune checkpoint inhibitors

作　　者：吴珊珊 谢晓纯[2] 黄晓杰 高分飞 WU Shanshan;XIE Xiaochun;HUANG Xiaojie;GAO Fenfei(Department of Pharmacology,Shantou University Medical College,Guangdong Shantou 515041,China;Department of Pharmacy,Municipal People’s Hospital,Guangdong Jieyang 522000,China)

机构地区：[1]汕头大学医学院药理学教研室,广东汕头515041 [2]揭阳市人民医院药学部,广东揭阳522000

出　　处：《中国医院药学杂志》2024年第10期1199-1204,共6页Chinese Journal of Hospital Pharmacy

摘　　要：目的:探讨晚期食管鳞癌患者的临床特征和外周血生物标志物对接受免疫检查点抑制剂(ICIs)治疗的疗效及预后的影响,寻找ICIs治疗前的潜在预测指标。方法:收集2020年1月至2022年6月在揭阳市人民医院接受ICIs治疗的157例晚期食管癌患者资料,包括临床特征、外周血标志物等,根据纳入和排除标准,剔除治疗周期数小于2次、合并放疗、未规范治疗、资料不全、接受PD-1抑制剂治疗尚不足6个月且未出现进展或死亡的患者,筛选出符合条件的患者65例。评估其与持久临床获益(DCB)、无进展生存期(PFS)之间的关系。结果:共纳入65例晚期食管鳞癌患者,单因素分析显示基线淋巴细胞/单核细胞比值(LMR)≥3.64、白蛋白(ALB)≥38.75 g·L^(–1)和预后营养指数(PNI)≥44.40组的患者DCB更优,具有统计学意义(P<0.05);多因素分析提示基线LMR≥3.64和ALB≥38.75 g·L^(–1)是DCB的独立影响因素(P<0.05)。纳入患者中位PFS为6.7个月(95%CI:4.48~8.86),单因素分析显示基线体力状态(PS)评分0~1分、LMR≥3.64、ALB≥38.75 g·L^(–1)与PFS改善显著相关(P<0.05);多因素Cox回归分析显示基线LMR≥3.64和ALB≥38.75 g·L^(–1)的患者具有更长的PFS(P<0.05)。结论:基线LMR≥3.64和ALB≥38.75 g·L^(–1)与晚期食管鳞癌患者接受ICIs治疗后的预后呈正相关。OBJECTIVE To identify the potential pre-treatment predictors of immune checkpoint inhibitors(ICIs)and examine the effects of clinical characteristics and peripheral blood biomarkers on therapeutic efficacy and prognostic outcomes of patients with advanced esophageal squamous cell carcinoma on a therapy of ICIs.METHODS Clinical characteristics and peripheral blood biomarkers were recorded for 157 advanced esophageal squamous cell carcinoma patients on a therapy of ICIs at Jieyang People’s Hospital from January 2020 to June 2022.According to the inclusion and exclusion criteria,individuals with<2 treatment cycles,combined radiotherapy,non-standardized treatment,incomplete data and PD-1 inhibitor dosing for less than 6 months without progression or death were excluded and 65 eligible patients elected.Their correlations with durable clinical benefit(DCB)and progression-free survival(PFS)were evaluated.RESULTS Univariate analysis showed that individuals with baseline lymphocyte-to-monocyte ratio(LMR)≥3.64,albumin(ALB)≥38.75 g·L^(–1) and prognostic nutritional index(PNI)≥44.40 had better DCB with statistical significance(P<0.05).Multivariate analysis revealed that baseline LMR≥3.64 and ALB≥38.75 g·L^(–1) were independent influencing factors of DCB(P<0.05).Median PFS was 6.7 months(95%CI:4.48-8.86).Univariate analysis hinted at a significant association between baseline performance status(PS)score of 0-1,LMR≥3.64,ALB≥38.75 g·L^(–1) and improved PFS(P<0.05).Multivariate Cox regression analysis indicated that individuals with baseline LMR≥3.64 and ALB≥38.75 g·L^(–1) had longer PFS(P<0.05).CONCLUSION Baseline LMR≥3.64 and ALB≥38.75 g·L^(–1) are correlated positively with the prognosis of advanced esophageal squamous cell carcinoma patients on a therapy of ICIs.

关 键 词：食管癌 免疫检查点抑制剂 疗效 影响因素 

分 类 号：R969.3[医药卫生—药理学]