新辅助化疗联合免疫治疗对局部晚期胃癌主要病理反应的影响及其相关因素分析  

Impact of neoadjuvant chemotherapy combined with immunotherapy on major pathological response in locally advanced gastric cancer and its related factors

作　　者：赵嗣钰 郑琳 章鹏程 胡灿 应荣彪 章静 滕理送[1] Zhao Siyu;Zheng Lin;Zhang Pengcheng;Hu Can;Ying Rongbiao;Zhang Jing;Teng Lisong(Department of Surgical Oncology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Medical Oncology,Taizhou Cancer Hospital,Taizhou 317502,China;Department of Radiation Oncology,Taizhou Cancer Hospital,Taizhou 317502,China;Department of Gastroenterology,the First Affi liated Hospital,Zhejiang University School of Medicine,Hangzh ou 310000,China;Department of Gastric Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China;Departme nt of Surgical Oncology,Taizhou Cancer Hospital,Taizhou 317502,China)

机构地区：[1]浙江大学医学院附属第一医院肿瘤外科,浙江杭州310000 [2]台州市肿瘤医院肿瘤内科,浙江台州317502 [3]台州市肿瘤医院肿瘤放疗科,浙江台州317502 [4]浙江大学医学院附属第一医院消化内科,浙江杭州310000 [5]浙江省肿瘤医院胃外科,浙江杭州310022 [6]台州市肿瘤医院肿瘤外科,浙江台州317502

出　　处：《实用肿瘤杂志》2025年第1期27-37,共11页Journal of Practical Oncology

基　　金：国家自然科学基金项目(82074245);台州市科技基金项目(22ywb127);温岭市科技计划项目(2022S00052);温岭市科技计划项目(2023S00002)。

摘　　要：目的探索在局部晚期胃癌(locally advanced gastric cancer,LAGC)患者中新辅助化疗联合免疫治疗对于主要病理反应(major pathological response,MPR)的影响并识别最大受益的患者群体。方法回顾性收集浙江大学医学院附属第一医院2020年1月至2023年2月收治的107例接受新辅助化疗联合免疫治疗后行根治性手术的LAGC患者的临床资料,评估治疗效果和病理反应。分析不同基线特征、治疗方法、炎性反应指标及其变化率对MPR的影响。采用二元逻辑回归分析探讨影响MPR的独立影响因素。结果新辅助化疗联合免疫治疗的LAGC患者的MPR率高达42.1%,病理完全缓解(pathologic complete response,pCR)率高达19.6%。多因素二元逻辑回归分析显示,新辅助治疗前中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)≤2.64的患者病理达到MPR的可能性是NLR>2.64的患者的5.854倍(P<0.05)。结论新辅助化疗联合免疫治疗是LAGC有效的治疗手段,而基线NLR≤2.64是提高MPR率的有利因素。Objective To explore the impact of neoadjuvant chemotherapy combined with immunotherapy on the major pathological response(MPR)in patients with locally advanced gastric cancer(LAGC)and identify the population that benefits the most.Methods The clinical data of 107 LAGC patients who underwent radical surgery after receiving neoadjuvant chemotherapy combined with immunotherapy at the First Affiliated Hospital,Zhejiang University School of Medicine,from January 2020 to February 2023,were retrospectively collected to evaluate treatment outcomes and pathological responses.The influence of different baseline characteristics,treatment methods,inflammatory response indicators,and their rates of change on MPR was analyzed.Binary logistic regression analysis was used to investigate independent factors affecting MPR.Results The MPR rate in LAGC patients treated with neoadjuvant chemotherapy combined with immunotherapy was as high as 42.1%,and the pathologic complete response(pCR)rate was as high as 19.6%.Multivariate binary logistic regression analysis showed that the likelihood of achieving MPR in patients with a neutrophil-to-lymphocyte ratio(NLR)≤2.64 before neoadjuvant treatment was 4.854 times higher than that in patients with NLR>2.64(P<0.05).Conclusions Neoadjuvant chemotherapy combined with immunotherapy is an effective treatment modality for LAGC,and a baseline NLR≤2.64 is a favorable factor for increasing the MPR rate.

关 键 词：局部晚期胃癌 炎性反应指标 新辅助免疫治疗 病理反应 

分 类 号：R735.2[医药卫生—肿瘤]