胃癌合并腹膜转移的一线免疫治疗分析  

Efficacy analysis of immunotherapy for gastric cancer with peritoneal metastasis

作　　者：朱博韬 冀扬 种晓艺 丛琳 王雅坤[1] 齐长松 张小田[1] Zhu Botao;Ji Yang;Zhong Xiaoyi;Cong Lin;Wang Yakun;Qi Changsong;Zhang Xiaotian(Department of Gastrointestinal Oncology,State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,Beijing Key Laboratory of Carcinogenesis and Translational Research,Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Gastroenterology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所,消化肿瘤内科,消化系肿瘤整合防治全国重点实验室,恶性肿瘤转化研究北京市重点实验室,北京100142 [2]首都医科大学附属北京潞河医院消化内科,北京101149

出　　处：《肿瘤综合治疗电子杂志》2024年第4期43-51,共9页Journal of Multidisciplinary Cancer Management(Electronic Version)

基　　金：国家自然科学基金面上项目(82272627);北京市自然科学基金项目(Z20J00105)。

摘　　要：目的探究免疫治疗对胃癌合并腹膜转移(gastric cancer peritoneal metastasis,GCPM)患者的疗效。方法回顾性收集2019—2023年北京大学肿瘤医院既往未接受全身治疗的同时性GCPM患者191例的临床资料,按照治疗方法分为接受免疫治疗组(n=87)和未接受免疫治疗组(n=104),并根据两组患者的基线特征对不同亚组进行分析,同时按程序性死亡受体配体1(programmed death-ligand 1,PD-L1)联合阳性分数(combined positive score,CPS)评分、抗人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)和CLDN18.2表达情况对免疫治疗组进行亚组分析。比较两组患者的临床疗效和不同亚组间患者的中位无进展生存(median progression-free survival,mPFS)时间和中位总生存(median overall survival,mOS)时间。结果接受免疫治疗组患者mOS时间较未接受免疫治疗组有延长趋势(20.7个月∶17.2个月,P=0.05)。接受免疫治疗组患者和未接受免疫治疗组患者的mPFS时间无明显差异(5.9个月∶6.0个月,P=0.40)。进一步分析生物标志物表达和免疫治疗获益的关系,结果显示,在GCPM患者中,HER-2阳性患者接受免疫联合化疗的OS时间优于单纯化疗,而CLDN18.2和PD-L1的表达情况均未能预测联合免疫治疗的获益情况。结论联合免疫治疗相比单纯化疗可以一定程度延长GCPM患者的OS时间,但仍需对适合免疫治疗的人群进行筛选和优化治疗方案。免疫治疗亚组分析揭示了不同分子分型和临床特征GCPM人群在接受免疫治疗后的获益情况,可协助筛选适合免疫治疗的人群。Objective To investigate the efficacy of immunotherapy for patients with gastric cancer peritoneal metastasis(GCPM).Method Study retrospectively analyzed 191 patients with synchronous GCPM who had not received systemic treatment at Peking University Cancer Hospital from 2019 to 2023.The patients were divided into immunotherapy group(n=87)and nonimmunotherapy group(n=104),and the clinical efficacy of the two groups was compared with analysis of subgroups according to baseline characteristics.Analysis was also conducted on the immunotherapy group along according to programmed death-ligand 1(PD-L1)combined positive score(CPS)score,expression of human epidermal growth factor receptor-2(HER-2),and CLDN18.2.The clinical efficacy,median progression-free survival(mPFS)time and median overall survival(mOS)time were compared between the two groups.Result Patients in the immunotherapy group showed a trend of longer mOS compared to those who did not receive immunotherapy(20.7 months∶17.2 months,P=0.05).There was no significant difference in mPFS between the two groups(5.9 months∶6.0 months,P=0.40).Further analysis of the correlation between biomarker expression and benefits of immunotherapy revealed that among the GCPM,patients with HER-2 positive tumors who received immunotherapy combined with chemotherapy had better OS compared to those receiving chemotherapy alone.The expression of CLDN18.2 and PD-L1 did not show difference as a biomarker for predicting efficacy of immunotherapy.Conclusion When combined with immunotherapy,GCPM patients may have better OS compared to chemotherapy alone,but further optimization of the treatment regimen for the suitable population are needed.Subgroup analyses of immunotherapy reveal the benefits for different molecular phenotypes and clinical characteristics of the GCPM population,aiding in the selection of patients who can benefit from immunotherapy.

关 键 词：胃癌 腹膜转移 免疫治疗 疗效评估 程序性死亡受体配体1 联合阳性分数 

分 类 号：R735.2[医药卫生—肿瘤]