PD-1抑制剂联合紫杉醇和顺铂新辅助治疗局部晚期下咽鳞癌的疗效分析  

Efficacy of PD-1 inhibitors combined with nab-paclitaxel and cisplatin in the neoadjuvant treatment of locally advanced hypopharyngeal squamous cell carcinoma

作　　者：方琦 徐鹏飞 曹非 赵政 张欣睿[2] 吴迪[1] 陈春燕[1] 李志铭[1] 韩非[1] 刘学奎[1] Fang Qi;Xu Pengfei;Cao Fei;Zhao Zheng;Zhang Xinrui;Wu Di;Chen Chunyan;Li Zhiming;Han Fei;Liu Xuekui(Department of Head and Neck Surgery,Center for Cancer Prevention and Control,Sun Yat-sen University,South China State Key Laboratory of Oncology,Collaborative Innovation Center of Oncology,Guangdong Clinical Medical Research Center for Malignant Tumors,Guangzhou 510060,China;Department of Otorhinolaryngology,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510799,China)

机构地区：[1]中山大学肿瘤防治中心头颈外科、华南肿瘤学国家重点实验室肿瘤学协同创新中心、广东省恶性肿瘤临床医学研究中心,广州510060 [2]广州医科大学附属第五医院耳鼻喉科,广州510799

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第7期750-757,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析程序性细胞死亡蛋白1(programmed cell death protein 1,PD-1)抑制剂联合紫杉醇(白蛋白结合型)和顺铂(TP方案)新辅助治疗局部晚期下咽鳞状细胞癌(简称鳞癌)的疗效,并评估喉器官功能保留率。方法回顾性分析2019年1月1日至2023年1月15日在中山大学肿瘤防治中心初治,经组织学和增强CT确诊为局部晚期下咽鳞癌的53例患者资料,其中男性51例,女性2例,年龄38~70岁。患者均接受PD-1抑制剂联合白蛋白结合型紫杉醇(260 mg/m2)和顺铂(60 mg/m2)新辅助治疗3~4周期。主要观察指标为喉器官功能保全生存期(larynx dysfunction-free survival,LDFS)、总生存期(OS)和无进展生存期(PFS)。使用Kaplan-Meier法绘制生存曲线,Cox单因素分析有统计学意义者进一步行Cox多因素分析。结果总体治疗有效率为90.6%(48/53)。1年、2年LDFS率为83.8%(95%CI:74.0%~94.8%)和50.3%(95%CI:22.1%~91.6%),1年、2年OS率为95.2%(95%CI:88.9%~100.0%)和58.2%(95%CI:25.6%~81.8%),1年、2年PFS率为83.9%(95%CI:74.2%~94.9%)和53.5%(95%CI:32.1%~89.1%)。新辅助治疗相关的不良事件主要为骨髓抑制(45.3%)、胃肠道反应(37.7%)和甲状腺功能减退(20.8%)。结论在PD-1抑制剂联合紫杉醇和顺铂新辅助治疗局部晚期下咽鳞癌中,可在保证较高生存率的同时提高患者喉器官功能保留率。Objective To assess the efficacy of neoadjuvant treatment with PD-1(programmed cell death protein 1)inhibitors combined with paclitaxel(albumin-conjugated)and cisplatin(TP regimen)for locally advanced hypopharyngeal squamous cell carcinoma and laryngeal organ function preservation.Methods Data of 53 patients,including 51 males and 2 females,aged 38-70 years old,who were diagnosed with locally advanced hypopharyngeal squamous carcinoma confirmed by histology and enhanced CT at the Cancer Prevention and Control Center of Sun Yat-sen University during the initial treatment from January 1,2019 to January 15,2023,were retrospectively analyzed.All patients received neoadjuvant therapy with PD-1 inhibitors combined with albumin-bound paclitaxel(260 mg/m 2)and cisplatin(60 mg/m 2)for 3 to 4 cycles.The main outcome measures were larynx dysfunction-free survival(LDFS),overall survival(OS),and progression-free survival(PFS).Survival curves were plotted using the Kaplan-Meier method,and Cox multifactorial analysis was further performed if Cox univariate analysis was statistically significant.Results The overall efficiency was 90.6%(48/53).The 1-year and 2-year LDFS rates were 83.8%(95%CI:74.0%to 94.8%)and 50.3%(95%CI:22.1%to 91.6%),the 1-year and 2-year OS rates were 95.2%(95%CI:88.9%to 100.0%)and 58.2%(95%CI:25.6%to 81.8%),and the 1-year and 2-year PFS rates were 83.9%(95%CI:74.2%to 94.9%)and 53.5%(95%CI:32.1%to 89.1%).Adverse events associated with the neoadjuvant therapy were mainly myelosuppression(45.3%),gastrointestinal reactions(37.7%)and hypothyroidism(20.8%).ConclusionThe neoadjuvant treatment of locally advanced hypopharyngeal squamous cell carcinoma using PD-1 inhibitors combined with paclitaxel and cisplatin can provide with a higher survival rate with a improved laryngeal organ function preservation rate.

关 键 词：下咽肿瘤 癌 鳞状细胞 新辅助治疗 免疫治疗 PD-1抑制剂 

分 类 号：R739.63[医药卫生—肿瘤]