术前放化疗联合PD-1抑制剂治疗溃疡性结肠炎相关性结直肠癌的疗效观察  

Preoperative chemoradiotherapy combined with PD-1 inhibitors in treating ulcerative colitisassociated colorectal cancer:an efficacy evaluation

作　　者：赵阳程 单留群 程功名 丁永斌[1] Zhao Yangcheng;Shan Liuqun;Cheng Gongming;Ding Yongbin(Department of General Surgery,the First Affiliated Hospital with Nanjing Medical University,Jiangsu Nanjing 210029,China;Department of General Surgery,the Second Hospital of Nanjing,Jiangsu Nanjing 210003,China)

机构地区：[1]南京医科大学第一附属医院普外科,江苏南京210029 [2]南京市第二医院普外科,江苏南京210003

出　　处：《腹部外科》2025年第2期118-122,共5页Journal of Abdominal Surgery

摘　　要：目的探讨术前新辅助放化疗联合程序性死亡受体1(programmed cell death-1,PD-1)抑制剂治疗溃疡性结肠炎相关性结直肠癌(ulcerative colitis related colorectal cancer,UCRCC)的近期效果。方法回顾性收集2021年3月至2023年12月于南京市第二医院接受PD-1抑制剂联合新辅助放化疗并进行手术的UCRCC病人的临床资料。根据术前治疗方案分为对照组(n=46)和联合组(n=34)。对照组术前病人仅接受卡培他滨+奥沙利铂方案化疗2个周期,休息2周后再进行2周期的放疗;联合组病人在对照组基础上术前给予PD-1抑制剂,每3周1次,共2周期。两组病人新辅助放化疗结束后4~6周行手术治疗,结直肠全切+回肠造瘘或肠道肿瘤根治术。比较两组病人新辅助治疗效果、肿瘤标志物水平、药物不良反应情况、围手术期相关指标水平以及术后病理情况。结果联合组疾病控制率显著高于对照组(P<0.05)。联合组糖类抗原242、糖类抗原72-4、癌胚抗原、糖类抗原19-9水平显著低于对照组(P<0.05),肿瘤退缩分级0级和1级的比例显著高于对照组。两组病人不良反应发生率和围手术期相关指标比较无显著差异(P>0.05)。结论术前新辅助放化疗联合PD-1抑制剂对UCRCC的控制效果良好,可降低病人肿瘤标志物水平,改善病人术后病理情况,具有一定安全性。Objective To investigate the short-term effect of preoperative neoadjuvant chemoradiotherapy combined with programmed cell death 1(PD-1)inhibitors on the treatment of ulcerative colitis related colorectal cancer(UCRCC).Methods Clinical data of UCRCC patients who received PD-1 inhibitors combined with neoadjuvant therapy and surgically operated in the Second Hospital of Nanjing from March 2021 to December 2023 were retrospectively collected.Patients were divided into the control group(n=46)and combination group(n=34)based on preoperative treatment regimens.Patients in the control group received two cycles of capecitabine+oxaliplatin chemotherapy preoperatively,followed by two cycles of radiotherapy after a 2-week rest.Those in the combination group received PD-1 inhibitors every 3 weeks for two cycles,plus clinical management as the same as in the control group.All patients underwent surgery(total colorectal resection with ileostomy or radical intestinal tumor resection)4-6 weeks after neoadjuvant chemoradiotherapy.The effect of neoadjuvant therapy,tumor markers,drug toxicity,side effects,perioperative indicators and postoperative pathology were compared between the two groups.Results Disease control rate in the combination group was significantly higher than that of the control group(P<0.05).The levels of carbohydrate antigen 242,carbohydrate antigen 72-4,carcinoembryonic antigen and carbohydrate antigen 199 in the combination group were significantly lower than those of the control group(P<0.05),and the percentage of tumor regression grades 0 and 1 was significantly higher compared to the control group.There were no significant differences in the incidence of toxic and side effects and perioperative indexes between the two groups(P>0.05).Conclusion Preoperative neoadjuvant chemoradiotherapy combined with PD-1 inhibitors demonstrates favorable efficacy in controlling UCRCC,reducing tumor marker levels,improving postoperative pathological outcomes,and exhibiting an acceptable safety profile.

关 键 词：新辅助放化疗 PD-1抑制剂 溃疡性结肠炎相关性结直肠癌 手术治疗 

分 类 号：R735.3[医药卫生—肿瘤]