叶酸受体阳性循环肿瘤细胞对可切除Ⅲ期鳞癌患者新辅助化疗联合免疫治疗后疗效的预测价值  

The predictive value of folate receptor-positive circulating tumor cells in patients with resectable stageⅢsquamous cell carcinoma after neoadjuvant chemotherapy combined with immunotherapy

作　　者：刘洋[1] 杨磊[1] 韩毅[1] Liu Yang;Yang Lei;Han Yi(Department of Thoracic Surgery,Beijing Chest Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京胸科医院胸外科,北京101100

出　　处：《首都医科大学学报》2024年第4期654-659,共6页Journal of Capital Medical University

基　　金：北京市属医学科研院所公益发展改革试点项目(JYY2023-14)。

摘　　要：目的研究治疗后叶酸受体阳性循环肿瘤细胞(folate receptor-positive circulating tumour cells,FR+-CTCs)对可切除Ⅲ期鳞癌患者新辅助化学药物治疗(以下简称化疗)联合免疫治疗疗效的预测价值。方法收集首都医科大学附属北京胸科医院2021年6月至2023年6月入院可切除Ⅲ期鳞癌患者,经过2周期新辅助化疗联合免疫治疗,记录患者以下指标:①一般临床资料:年龄、性别、临床分期、肿瘤位置、治疗前后白细胞计数;②治疗前后肿瘤标志物——血清癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA 21-1)、鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCC)、FR+-CTCs数据;③患者术后病理结果,根据术后病理结果将患者分为两组,肿瘤病灶在病理层面上残存肿瘤细胞占比≤10%(缓解组,E组),肿瘤病灶在病理层面上残存肿瘤细胞占比>10%(NE组),比较E组和NE组患者的一般临床资料,治疗前后白细胞计数、肿瘤标志物和FR+-CTCs水平,将组间比较差异有统计学意义的变量纳入二元Logistic回归分析,统计分析出可切除Ⅲ期鳞癌患者新辅助化疗联合免疫治疗疗效的影响因素,采用受试者工作特征(receiver operating characteristics,ROC)曲线分析FR+-CTCs对其的预测价值。结果最终纳入24例患者,E组15例,NE组9例,两组患者一般临床资料、治疗前CEA、CYFRA 21-1、SCC、FR+-CTCs比较差异均无统计学意义(P>0.05),治疗后CEA、CYFRA 21-1、SCC差异无统计学意义(P>0.05),E组治疗后FR+-CTCs显著低于NE组(P<0.05),二元Logistic回归分析显示,治疗后FR+-CTCs(OR=1.28,95%CI:1.00~1.63,P=0.047)是新辅助化疗联合免疫治疗的影响因素,ROC分析显示,治疗后FR+-CTCs截点值为10.10,特异度0.87,灵敏度0.89,曲线下面积(area under the curve,AUC)0.837。结论对可切除Ⅲ期鳞癌患者,治疗后FR+-CTCs低于10.10 FU/3 mL是预测新辅助化疗联合免疫治疗缓解效果的可靠指标Objective To investigate the predictive value of folate receptor-positive circulating tumor cells(FR+-CTCs)in determining the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stageⅢsquamous cell carcinoma.Methods A total of patients diagnosed with resectable stageⅢsquamous cell carcinoma and admitted to Beijing Chest Hospital from June 2021 to June 2023 were included in this study.After receiving 2 cycles of neoadjuvant chemotherapy combined with immunotherapy,the following parameters were recorded:①general clinical data including age,gender,clinical stage,tumor location,pre-and post-treatment white blood cell count;②levels of tumor markers such as serum carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA 21-1),squamous cell carcinoma antigen(SCC),and FR+-CTCs before and after treatment;③postoperative pathological results,based on which the patients were divided into two groups:group E(<10%residual tumor cells)and NE group(>10%residual tumor cells).Binary Logistic regression analysis was performed using general clinical data,white blood cell count,tumor marker data,and FR+-CTCs data before and after treatment to statistically analyze factors influencing the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stageⅢsquamous cell carcinoma.The predictive value of FR+-CTCs was assessed using receiver operating characteristics(ROC)curve analysis.Results A total of 24 patients were included in this study,with 15 patients in group E and 9 patients in the NE group.There were no significant differences observed between the two groups regarding general clinical data or pre-treatment levels of CEA,CYFRA 21-1,SCC or FR+-CTCs(P>0.05).Additionally,no statistically significant differences were found for CEA,CYFRA21-1,and SCC levels after treatment.FR+-CTCs in group E was significantly lower than that in group NE(P<0.05).Binary Logistic regression analysis showed that FR+-CTCs after treatment(OR=1.28,95%CI:1.00-1.63,P=0.047)

关 键 词：鳞癌 叶酸受体阳性循环肿瘤细胞 新辅助化疗联合免疫 

分 类 号：R734.2[医药卫生—肿瘤]