摘要
目的:探讨卡瑞利珠单抗联合白蛋白紫杉醇和顺铂一线治疗晚期食管癌的疗效及对外周血程序性死亡受体1(PD-1)、程序性死亡受体配体1(PD-L1)的影响。方法:选取2019年7月至2020年10月该院收治的晚期食管癌患者80例作为研究对象进行前瞻性研究,按照随机数字表法按1∶1比例分为观察组、对照组,各40例。对照组患者采用白蛋白紫杉醇、顺铂治疗,观察组患者采用卡瑞利珠单抗联合白蛋白紫杉醇、顺铂治疗。比较两组患者的疗效,治疗前后肿瘤标志物[鳞状细胞癌相关抗原(SCC-Ag)、糖类抗原19-9(CA19-9)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)和癌胚抗原(CEA)]、免疫功能指标[T细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、树状突细胞(DC)和DC/单核巨噬细胞(PBMC)]和血清PD-1、PD-L1水平,生活质量核心量表(QLQ-C30)评分及治疗期间不良反应发生情况,随访1年统计两组患者的生存情况。结果:观察组患者的疾病控制率为77.50%(31/40),较对照组(55.00%,22/40)明显更高,差异有统计学意义(P<0.05)。治疗后,观察组患者血清CA19-9、CEA、CYFRA21-1和SCC-Ag水平较对照组明显更低,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、DC和DC/PBMC水平较对照组明显更高,血清PD-1、PD-L1水平较对照组明显更低,QLQ-C30评分较对照组明显更低,差异均有统计学意义(P<0.05)。两组患者不良反应发生率的差异无统计学意义(P>0.05)。观察组患者的生存率为89.47%(34/38),明显高于对照组的70.27%(26/37),差异有统计学意义(P<0.05)。结论:卡瑞利珠单抗联合白蛋白紫杉醇和顺铂一线治疗晚期食管癌患者的效果显著,可有效调节血清PD-1、PD-L1的表达,提高免疫功能及生活质量,降低肿瘤标志物水平,且安全性高,生存期更长。
OBJECTIVE:To probe into the efficacy of carrelizumab combined with albumin paclitaxel and cisplatin in the first-line treatment of patients with advanced esophageal cancer and effects on peripheral blood programmed death receptor 1(PD-1)and programmed death receptor ligand 1(PD-L1).METHODS:Eighty patients with advanced esophageal cancer admitted to the hospital from Jul.2019 to Oct.2020 were extracted to be divided into the observation group and the control group at the ratio of 1∶1 according to the random number table method,with 40 cases in each group.The control group was treated with albumin paclitaxel and cisplatin,while the observation group received carrelizumab combined with albumin paclitaxel and cisplatin.The efficacy and levels of tumor markers[squamous cell carcinoma-associated antigen(SCC-Ag),carbohydrate antigen 19-9(CA19-9),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA)],immune function indicators[T cell subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),dendritic cells(DC),DC/mononuclear macrophages(PBMC)],serum PD-1,PD-L1,the core quality of life scale(QLQ-C30)score before and after treatment and the incidence of adverse reactions during treatment were compared between two groups.The survival of patients in both groups was counted at 1 year of follow-up.RESULTS:The disease control rate of the observation group was 77.50%(31/40),significantly higher than 55.00%(22/40)of the control group,with statistically significant difference(P<0.05).After treatment,the serum levels of CA19-9,CEA,CYFRA21-1 and SCC-Ag in the observation group were lower than those in the control group,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),DC and DC/PBMC in the observation group were higher than those in the control group,the serum levels of PD-1 and PD-L1 in the observation group were lower than those in the control group,the QLQ-C30 score of the observation group was lower than that of the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between two groups(P>0.05).The survival rate of the observation group was 89.47%(34/38),higher than 70.27%(26/37)of the control group,with statistically significant difference(P<0.05).CONCLUSIONS:The efficacy of carrelizumab combined with albumin paclitaxel and cisplatin in the first-line treatment of patients with advanced esophageal cancer is significant,which can effectively regulate the expression of serum PD-1 and PD-L1,improve the immune function and quality of life,reduce the levels of tumor markers,with higher safety and longer survival time.
作者
黄慧
龙亚辉
谭玲霞
税明才
HUANG Hui;LONG Yahui;TAN Lingxia;SHUI Mingcai(Dept.of Oncology,People’s Hospital of Kaizhou District,Chongqing 405400,China)
出处
《中国医院用药评价与分析》
2022年第4期444-448,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
重庆市卫生计生委医学科研计划面上项目(No.2019MSXM0350146)。
作者简介
黄慧,主治医师,硕士。研究方向:肿瘤内科治疗。E-mail:huanghui88012@163.com;通信作者:税明才,副主任医师。研究方向:肿瘤放射治疗学。E-mail:1203687196@qq.com。
