放疗联合免疫治疗对局部晚期不可切除食管鳞癌的疗效及预后分析  

Efficiency and Prognostic Factors of Radiotherapy Plus Immunotherapy for Locally Advanced Unresectable Esophageal Squamous Cell Carcinoma

作　　者：谢良云 侯俊志 刘珣 刘睿[2] 张志[2] XIE Liangyun;HOU Junzhi;LIU Xun;LIU Rui;ZHANG Zhi(Hebei Medical University,Shijiazhuang,China,050011;Department of Oncology,Affiliated Tangshan Worker’s Hospital,Hebei Medical University,Tangshan,China,063003)

机构地区：[1]河北医科大学,河北石家庄050011 [2]河北医科大学附属唐山市工人医院,河北唐山063003

出　　处：《食管疾病》2024年第4期267-273,278,共8页Journal of Esophageal Diseases

摘　　要：目的探讨放疗联合免疫治疗在不可手术局部晚期食管鳞癌中的疗效及预后相关因素。方法选取2019年8月至2023年3月确诊并接受放疗联合免疫治疗的不可手术局部晚期食管鳞癌63例,记录疗效及预后,综合分析患者年龄,性别,ECOG评分,病理分级、病灶位置、病灶长度(钡餐造影)、AJCC临床分期、放疗时机、放疗剂量、免疫治疗周期、吸烟史、饮酒史以及基线水平的NLR、PLR、LMR、FIB、DD、ALB、ALP等指标对预后的影响。结果63例患者客观缓解率为62%,疾病控制率为92%;单因素分析:年龄、病灶长度、AJCC临床分期、免疫治疗周期以及基线水平的LMR、FIB、DD、ALP水平与预后有明显相关性(P<0.05);而性别、ECOG评分、病理分级、病灶部位、放疗时机、放疗剂量、吸烟史、酗酒史以及基线水平的NLR、PLR、FIB、ALB与预后无明显相关性(P>0.05);经COX多因素回归分析:病灶长度、免疫治疗周期、基线LMR水平、基线DD水平是患者预后的独立危险因素(P<0.05)。结论放疗联合免疫治疗对不可手术局部ESCC患者有较好的疗效及生存获益,且安全可控,病灶长度﹥9.4 cm、免疫治疗周期≤5周期、基线LMR水平>2.7、基线DD水平>106μg是影响患者预后的高危因素。Objective To explore the efficiency and prognostic factors of radiotherapy plus immunotherapy for unresectable locally advanced esophageal squamous cell carcinoma.Methods 63 patients with unresectable locally advanced esophageal squamous cell carcinoma who received radiotherapy combined with immunotherapy from August 2019 to March 2023 were selected,and the treatment effect and prognosis were recorded.The age,sex,ECOG,grade,tumor location,tumor size,AJCC stage,timing of radiotherapy,radiotherapy dose,immunotherapy cycle,smoking history,drinking history,baseline NLR,PLR,LMR,FIB,DD,ALB,ALP of the patients were collected to analysis the prognostic factors of radiotherapy and immunotherapy combined with unresectable locally advanced ESCC.Results The ORR of 63 patients was 62%and the DCR was 92%.Univariate analysis showed that age,tumor size,AJCC stage,immunotherapy cycle,baseline LMR,DD,ALP were related to the efficacy of the unresectable locally advanced ESCC with radiotherapy plus immunotherapy(P<0.05);Sex,ECOG,grade,tumor location,timing of radiotherapy,radiotherapy dose,smoking history,drinking history,baseline NLR,PLR,FIB,ALB were not related to the efficacy of the unresectable locally advanced ESCC with radiotherapy plus immunotherapy(P>0.05).Multivariate analysis showed that tumor size,immunotherapy cycle,baseline LMR,and baseline DD were independent risk factors affecting the prognosis of unresectable locally advanced ESCC with radiotherapy plus immunotherapy(P﹤0.05).Conclusion Radiotherapy plus immunotherapy is effective in the unresectable locally advanced ESCC.Tumor size>9.4 cm,immunotherapy cycle≤5,baseline LMR>2.7,and baseline DD>106μg were high-risk factors affecting the prognosis of unresectable locally advanced ESCC with radiotherapy plus immunotherapy.

关 键 词：食管鳞癌 不可切除 免疫治疗 放疗 预后 影响因素 

分 类 号：R735.1[医药卫生—肿瘤]