免疫治疗在局部进展期胃癌新辅助治疗中的短期疗效分析  

Analysis of short-term efficacy of immunotherapy in neoadjuvant therapy for locally advanced gastric cancer

作　　者：周丽平 杨朝纲[1] 梅列军[2] 熊斌[1] Zhou Liping;Yang Chaogang;Mei Liejun;Xiong Bin(Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Radiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院胃肠外科,湖北武汉430071 [2]武汉大学中南医院医学影像科,湖北武汉430071

出　　处：《实用肿瘤杂志》2025年第2期152-158,共7页Journal of Practical Oncology

摘　　要：目的探究免疫治疗在局部进展期胃癌(locally advanced gastric cancer,LAGC)的新辅助治疗中的短期疗效和安全性。方法回顾性分析2021年9月至2023年12月在本院接受新辅助治疗的73例LAGC患者的临床病理资料,根据是否加免疫治疗将患者分为新辅助免疫联合化疗组(n=38)和单纯化疗组(n=35)。分析两组患者的短期疗效,包括客观缓解率(overall response rate,ORR)、疾病控制率(disease control rate,DCR)、病理完全缓解(pathologic complete response,pCR)率和主要病理缓解(main pathologic response,MPR)率,并进行亚组分析以探究新辅助免疫治疗的优势人群。结果新辅助免疫联合化疗组和单纯化疗组患者的ORR分别为47.4%和14.3%(P=0.002),而DCR分别为97.4%和91.4%(P>0.05)。新辅助免疫联合化疗组在整体肿瘤退缩分级(tumor regression grade,TRG)方面优于单纯化疗组(P=0.049),pCR更高(25.0%vs 3.3%,P=0.023),而在MPR方面,差异无统计学意义(42.9%vs 23.3%,P>0.05)。根据程序性死亡受体配体1(programmed deathligand 1,PD-L1)进行亚组分析发现,联合阳性评分(combined positive score,CPS)≥1和CPS<1的患者在TRG分级、pCR和MPR方面比较,差异均无统计学意义(均P>0.05),CPS≥5和CPS<5的患者pCR分别为100.0%和13.6%(P<0.05),而MPR分别为100.0%和36.4%(P>0.05)。临床分期为Ⅱ期的患者中,新辅助免疫联合化疗组和单纯化疗组在TRG分级、pCR和MPR上比较,差异均无统计学意义(均P>0.05);而在Ⅲ期患者中,新辅助免疫联合化疗组TRG分级更优(P=0.026),pCR更高(31.6%vs 0.0%,P=0.024),但在MPR方面,两组比较差异无统计学意义(P>0.05)。两组在新辅助治疗期间所有不良反应与3~4级不良反应的发生率和围手术期并发症的发生率方面比较,差异均无统计学意义(均P>0.05)。结论免疫治疗在LAGC的新辅助治疗中具有良好的短期疗效和安全性,特别是在PD-L1 CPS≥5和Ⅲ期的患者中,可提高pCR,但其长期疗效需进一步的随访和临�Objective To explore the short-term efficacy and safety of immunotherapy in the neoadjuvant therapy for locally advanced gastric cancer(LAGC).Methods The clinicopathological data of 73 LAGC patients who received neoadjuvant therapy at our hospital from September 2021 to December 2023 were retrospectively analyzed.The patients were divided into the neoadjuvant immunotherapy combined with chemotherapy group(n=38)and the chemotherapy alone group(n=35)according to whether immunotherapy was added.The short-term efficacy of the two groups was analyzed,including overall response rate(ORR),disease control rate(DCR),pathologic complete response(pCR)rate and main pathologic response(MPR)rate.Subgroup analysis was performed to explore the population that could benefit from neoadjuvant immunotherapy.Results The ORRs of the neoadjuvant immunotherapy combined with chemotherapy group and the chemotherapy alone group were 47.4%and 14.3%,respectively(P=0.002),while the DCRs were 97.4%and 91.4%,respectively(P>0.05).The neoadjuvant immunotherapy combined with chemotherapy group was superior to the chemotherapy alone group in terms of the overall tumor regression grade(TRG,P=0.049),with an increased pCR rate(25.0%vs 3.3%,P=0.023).However,there was no significant difference in MPR between the two groups(42.9%vs 23.3%,P>0.05).Subgroup analysis based on programmed death-ligand 1(PD-L1)showed that there were no significant differences in TRG,pCR,and MPR between patients with combined positive score(CPS)≥1 and CPS<1(all P>0.05).The pCR rates of patients with CPS≥5 and CPS<5 were 100.0%and 13.6%,respectively(P<0.05),while the MPR rates were 100.0%and 36.4%,respectively(P>0.05).Among patients with clinical stageⅡ,there were no significant differences in TRG,pCR,and MPR between the neoadjuvant immunotherapy combined with chemotherapy group and the chemotherapy alone group(all P>0.05).In patients with stageⅢ,the neoadjuvant immunotherapy combined with chemotherapy group had a better TRG(P=0.026)and an increased pCR rate(31.6%vs 0.0%,

关 键 词：局部进展期胃癌 免疫治疗 新辅助化疗 短期疗效 安全性 

分 类 号：R73[医药卫生—肿瘤]