抗核抗体对食管鳞癌化疗免疫疗效的预测分析  

Study on antinuclear antibodies predicting the response to chemoimmunotherapy of esophageal squamous cell carcinoma

作　　者：孙武 吴成 王涛[2] 胡振东 李安苏 陈蓉[5] 任伟[1] SUN Wu;WU Cheng;WANG Tao;HU Zhendong;LI Ansu;CHEN Rong;REN Wei(The Comprehensive Cancer Center of Drum Tower Hospital,Medical School of Nanjing University/Clinical Cancer Institute of Nanjing University,Nanjing 210008,China;Department of Pulmonary Surgery,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Esophageal Surgery,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Clinical Laboratory,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Radiotherapy,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院肿瘤中心/南京大学临床肿瘤研究所,江苏南京210008 [2]南京大学医学院附属鼓楼医院肺外科,江苏南京210008 [3]南京大学医学院附属鼓楼医院食管外科,江苏南京210008 [4]南京大学医学院附属鼓楼医院医学检验科,江苏南京210008 [5]东南大学附属中大医院放疗科,江苏南京210009

出　　处：《东南大学学报(医学版)》2025年第2期167-174,共8页Journal of Southeast University(Medical Science Edition)

基　　金：国家自然科学基金资助项目(82003198);吴阶平医学基金会临床科研专项基金项目(320.6750.2021-01-36);鼓楼医院新技术发展基金项目(XJSFZJJ202035);白求恩·中青年医师科研能力培养项目(BQE-TY-SSPC(7)-N-01)。

摘　　要：目的:探讨局部晚期(临床分期为cT_(2-4a)N_(1-3)或cT_(3-4a)N_(0)M_(0))食管鳞癌(ESCC)患者治疗前血清抗核抗体(ANA)对新辅助/转化化疗免疫治疗后疗效评估的预测价值。方法:回顾性分析2020年6月至2023年12月在南京大学医学院附属鼓楼医院肿瘤中心行新辅助/转化化疗免疫治疗的ESCC患者的临床资料。收集患者治疗前血清ANA表达水平及各项临床相关资料,采用卡方检验、单因素及多因素分析等统计方法,分析ANA及各项临床参数与患者的近期临床疗效及术后病理反应的相关性。结果:179例ESCC患者在接受了2周期化疗免疫治疗后行近期疗效评价,客观缓解率(ORR)为77.1%(138/179),疾病控制率(DCR)为98.3%。ANA阳性患者的ORR(86.9%)高于阴性患者(72.0%),差异有统计学意义(P<0.05);ANA阳性组和阴性组的DCR分别为100%和97.5%,差异无统计学意义(P>0.05)。138例中有97例实施手术切除,共24例(24.7%)达到病理完全缓解(pCR)。ANA阳性组的pCR率(39.3%)高于阴性组(18.8%),差异有统计学意义(P<0.05)。相对于男性,女性患者有更高的pCR率(P<0.05)。多因素分析显示,血清ANA阳性、女性是化疗免疫治疗后pCR的独立预测因素。结论:血清ANA可作为局部晚期ESCC患者新辅助/转化化疗免疫治疗后pCR预测的潜在生物标志物,值得进一步开展前瞻性研究深入探索。Objective:To investigate the predictive value of antinuclear antibody(ANA)on the assessment of the efficacy of neoadjuvant/conversion chemoimmunotherapy in patients with locally advanced esophageal squamous cell carcinoma(ESCC)(cT_(2-4a)N_(1-3)or cT_(3-4a)N_(0)M_(0)).Methods:This study retrospectively analyzed ESCC patients treated with neoadjuvant/conversion chemoimmunotherapy from June 2020 to December 2023.The parameters of serum ANA before treatment were collected,and Chi-square test,univariate and multivariate analyses were performed to assess the recent efficacy and postoperative pathological response.Results:The objective response rate(ORR)and disease control rate(DCR)were 90.5%and 100%in 179 patients,respectively.The ORR(86.9%)was higher in positive ANA group than that in negative ANA group(72.0%),and the difference was statistically significant(P<0.05).DCR in the positive and negative ANA group was 100%and 97.5%,respectively.Of the 179 patients,97 patients received surgery.A total of 24 cases(24.7%)achieved pathological complete response(pCR)after neoadjuvant/conversion chemoimmunotherapy.The pCR rate of ANA-positive patients(39.3%)was higher than that of ANA-negative patients(18.8%),and the difference was statistically significant(P<0.05).Compared with male patients,female patients had a higher pCR rate(P<0.05).Multivariate Logistic regression analysis showed that ANA positive and female were independent predictor of pCR in ESCC patients.Conclusion:Serum ANA can be used as a potential biomarker of pCR after neoadjuvant/conversion chemoimmunotherapy in patients with locally advanced ESCC.

关 键 词：食管鳞癌 新辅助/转化化疗免疫治疗 抗核抗体 病理完全缓解 

分 类 号：R735.1[医药卫生—肿瘤]