特瑞普利单抗联合化学治疗对局部晚期食管鳞癌患者免疫功能及预后的影响  

Effect of Toripalimab Combined with Chemotherapy on Immune Function and Prognosis in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

作　　者：赵佳[1] 慕腾 张国庆 李向楠[1] Zhao Jia;Mu Teng;Zhang Guoqing;Li Xiangnan(Department of Thoracic Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院胸外科,郑州450000

出　　处：《成都医学院学报》2024年第4期598-602,共5页Journal of Chengdu Medical College

基　　金：国家自然科学基金项目(No:32070623)。

摘　　要：目的探究特瑞普利单抗联合化学治疗对局部晚期食管鳞癌(ESCC)患者免疫功能及预后的影响。方法选取2019年3月至2023年3月在郑州大学第一附属医院就诊的115例局部晚期ESCC患者为研究对象,根据治疗方案不同,将其分为对照组[化学治疗(氟尿嘧啶^(+)顺铂),n=50]和观察组(特瑞普利单抗联合化学治疗,n=55),比较两组治疗前及治疗6个月后的免疫功能[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、CD4^(+)、CD8^(+)]、血清肿瘤标志物[血管内皮生长因子(VEGF)、鳞状细胞癌相关抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、血清可溶性PD-1(sPD-1)/PD-L1(sPD-L1)]、不良反应、近远期疗效[实体瘤疗效、无进展生存期(PFS)以及总生存时间(OS)]。结果治疗6个月后,两组患者IgA、IgM、CD4^(+)均高于治疗前,且观察组高于对照组(P<0.05);两组患者CD8^(+)、血清VEGF、SCC、CYFRA21-1、sPD-1/sPD-L1水平均低于治疗前,且观察组低于对照组(P<0.05)。两组患者不良反应比较,差异无统计学意义(P>0.05)。治疗6个月后,观察组患者疾病控制率(90.74%vs 75.00%)、客观缓解率(75.93%vs 52.08%)高于对照组(P<0.05);随访1年,两组患者生存率(75.93%vs 62.50%)比较,差异无统计学意义(P>0.05)。K-M结果显示,观察组的PFS为(9.04±1.83)个月,对照组的PFS为(7.22±1.27)个月,两组比较差异无统计学意义(P=0.412);观察组的OS为(10.94±2.04)个月,对照组的OS为(9.52±1.92)个月,两组比较差异无统计学意义(P=0.160)。结论在局部晚期ESCC患者中进行特瑞普利单抗联合氟尿嘧啶、顺铂治疗,能改善患者的免疫功能,提高近远期疗效。Objective To explore the effect of toripalimab combined with chemotherapy on the immune function and prognosis in patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods A total of 115 patients with locally advanced ESCC in the First Affiliated Hospital of Zhengzhou University from March 2019 to March 2023 were selected as the research objects.According to different treatment regimens,the patients were divided into the control group[chemotherapy(fluorouracil^(+)cisplatin),n=50]and the observation group(toripalimab combined with chemotherapy,n=55).The immune function[immunoglobulin A(IgA),immunoglobulin M(IgM),CD4^(+),CD8^(+)],serum tumor markers[vascular endothelial growth factor(VEGF),squamous cell carcinoma-associated antigen(SCC),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),and serum soluble PD-1(sPD-1)/PD-L1(sPD-L1)]before treatment and after 6 months of treatment,toxic and side effects,and short-term and long-term efficacy[the curative effect of solid tumors,progression-free survival(PFS)and overall survival(OS)]were compared between the two groups.Results After 6 months of treatment,the levels of IgA,IgM and CD4^(+)in both groups were higher than those before treatment,and the above indicators in the observation group were higher than those in the control group(P<0.05).And the levels of CD8^(+),serum VEGF,SCC,CYFRA21-1 and sPD-1/sPD-L1 in both groups were lower than those before treatment,and the above indicators in the observation group were lower than those in the control group(P<0.05).There were no statistical differences in toxic and side effects between the two groups(P>0.05).After 6 months of treatment,the disease control rate and objective remission rate of patients in the observation group were higher than those in the control group(90.74%vs 75.00%;75.93%vs 52.08%)(P<0.05).The survival rate showed no statistical difference between the two groups after 1 year of follow-up(75.93%vs 62.50%)(P>0.05).Kaplan-Meier(K-M)analysis results showed that the PFS of the observation group

关 键 词：食管鳞癌 特瑞普利单抗 化学治疗 免疫功能 预后 

分 类 号：R735.1[医药卫生—肿瘤]