新辅助化疗联合免疫治疗对食管癌根治术患者围术期肾功能的影响  

Effect of neoadjuvant chemotherapy combined with immunotherapy on perioperative renal function in patients undergoing radical resection for esophageal cancer

作　　者：王凯元 涂慧芳 邓城旗 关山 耳建旭 尹毅青 Wang Kaiyuan;Tu Huifang;Deng Chengqi;Guan Shan;Er Jianxu;Yin Yiqing(Department of Anesthesiology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin′s Clinical Research Center for Cancer,Tianjin 300060,China;Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Department of Anesthesiology,Tianjin University Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津医科大学肿瘤医院麻醉科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津300060 [2]天津中医药大学研究生院,天津301617 [3]天津大学胸科医院麻醉科,天津300222

出　　处：《中华麻醉学杂志》2024年第8期932-936,共5页Chinese Journal of Anesthesiology

基　　金：天津麻醉科研发展计划项目(TJMZ2021-M001);天津市"项目+团队"重点培养专项(创新类)(XC202034);天津市医学重点学科(专科)建设项目(TJYXZDXK-010A)。

摘　　要：目的评价新辅助化疗联合免疫治疗对食管癌根治术患者围术期肾功能的影响。方法本研究为回顾性队列研究。收集2020年1月至2022年4月于天津医科大学肿瘤医院和天津大学胸科医院行食管癌根治术患者的临床资料,根据患者术前治疗方案分为2组:新辅助化疗组(nCT组)和新辅助化学联合免疫治疗组(nCT+IT组)。nCT组接受以铂类药为基础,结合氟尿嘧啶或紫杉醇的新辅助化疗;nCT+IT组在接受新辅助化疗的基础上,联合使用程序性死亡受体1抗体药物进行免疫治疗。患者均接受了2~3个周期的治疗,每个周期21 d,在治疗完成后4~6周进行手术。收集治疗前、术前72 h及术后72 h的血清肌酐、尿酸及尿素浓度。采用KDIGO标准诊断急性肾损伤(AKI),记录术前72 h及术后72 h时AKI发生情况。收集患者术后病理完全缓解率、复发率和无病生存时间。结果与nCT组比较,nCT+IT组治疗后血清尿素浓度升高,术前72 h和术后72 h时血清尿酸浓度升高,术后病理完全缓解率升高,复发率降低,无病生存时间延长(P<0.05),术前72 h和术后72 h时AKI发生率差异无统计学意义(P>0.05)。结论新辅助化疗联合免疫治疗虽然可提高食管癌根治术患者病理完全缓解率和无病生存率,但对肾功能会产生一定的影响,围术期应加强肾功能检测,防止AKI的发生。ObjectiveTo evaluate the effect of neoadjuvant chemotherapy combined with immunotherapy on the perioperative renal function in patients undergoing radical resection for esophageal cancer.MethodsThis was a retrospective cohort study.Clinical data from patients undergoing neoadjuvant chemotherapy combined with immunotherapy for esophageal cancer in Tianjin Medical University Cancer Institute&Hospital and Tianjin University Chest Hospital from January 2020 to April 2022 were retrospectively collected.According to the preoperative treatment regimen,the patients were divided into neoadjuvant chemotherapy group(group nCT)and neoadjuvant chemotherapy combined with immunotherapy group(group nCT+IT).nCT group underwent neoadjuvant chemotherapy,which included a platinum-based regimen combined with fluorouracil or taxanes.In nCIT+IT group,programmed cell death protein 1 inhibitors were used for immunotherapy based on neoadjuvant chemotherapy.All the patients underwent 2-3 cycles of therapy,with each cycle lasting 21 days.Surgery was performed 4-6 weeks after the completion of the last therapy.The concentrations of serum creatinine,uric acid and blood urea nitrogen were detected before therapy,at 72 h before surgery and at 72 h after surgery.The acute kidney injury(AKI)diagnosed by the Kidney Disease:Improving Global Outcomes criteria at 72 h before surgery and 72 h after surgery were recorded.The pathological complete response rates,recurrence rate and disease-free survival time after surgery were collected.ResultsCompared with group nCT,the serum urea concentration was significantly increased after treatment,the serum uric acid concentrations were increased at 72 h before surgery and 72 h after surgery,the pathological complete response rate was increased,the recurrence rate was decreased,the disease-free survival time was prolonged(P<0.05),and no statistically significant changes were found in the incidence of AKI at 72 h before surgery and 72 h after surgery in group nCT+IT(P>0.05).ConclusionsAlthough neoadjuvant chemoth

关 键 词：新辅助化疗 免疫疗法 食管肿瘤 肾功能试验 

分 类 号：R735.1[医药卫生—肿瘤]