卡瑞利珠单抗联合白蛋白结合型紫杉醇对局部晚期食管癌患者的临床疗效

doi:10.11958/20240622

摘要/Abstract

摘要：

目的探讨卡瑞利珠单抗联合白蛋白结合型紫杉醇治疗局部晚期食管癌患者的临床疗效及安全性。方法将98例局部晚期食管癌患者随机分为研究组和对照组，每组49例。对照组给予白蛋白结合型紫杉醇治疗，研究组给予卡瑞利珠单抗联合白蛋白结合型紫杉醇治疗。治疗后评估总体疗效，计算疾病控制率；分别于治疗前、后采用酶联免疫吸附试验（ELISA）检测血清肿瘤标志物[高迁移率族蛋白B1（HMGB1）、鳞状细胞癌相关抗原（SCCA）]、程序性死亡蛋白1（PD-1）及其配体PD-L1水平，采用免疫组织化学法检测食管癌组织的微血管密度（MVD）及PD-1、PD-L1蛋白表达，采用流式细胞仪检测CD3^＋、CD4^＋、CD8^＋细胞百分比。对患者进行随访，记录不良反应及生存情况。结果研究组疾病控制率高于对照组（P<0.05）。治疗前，2组患者各指标差异无统计学意义（P>0.05）。治疗后，2组患者HMGB1水平、SCCA水平、MVD、血清PD-1水平、肿瘤组织PD-1高表达率均降低，血清PD-L1水平、PD-L1高表达率、CD3^＋、CD4^＋、CD8^＋细胞百分比均升高（P<0.05），且除MVD组间差异无统计学意义外，其余指标研究组均较对照组变化显著（P<0.05）。2组不良反应发生率差异无统计学意义（P>0.05）。研究组无进展生存率高于对照组（P<0.05）。结论卡瑞利珠单抗联合白蛋白结合型紫杉醇治疗局部晚期食管癌有助于控制病灶进展，抑制血管生成，且安全性较好。

关键词: 食管肿瘤, 微血管密度, 白蛋白结合型紫杉醇, 卡瑞利珠单抗

Abstract:

Objective To explore the clinical effect and safety of carrellizumab combined with albumin-bound paclitaxel on the treatment of patients with locally advanced esophageal cancer. Methods Ninety-eight patients with locally advanced esophageal cancer were randomly divided into the study group and the reference group, with 49 cases in each group. The reference group was treated with albumin-bound paclitaxel, while the study group was treated with camrelizumab+albumin-bound paclitaxel. After treatment, the overall efficacy was evaluated, and the disease control rate was calculated. Serum tumor markers [high mobility group protein B1 (HMGB1), squamous cell carcinoma associated antigen (SCCA)], PD-1 and PD-L1 levels were detected by enzyme-linked immunosorbent assay (ELISA) before and after treatment. Immunohistochemistry was used to detect the microvascular density (MVD) and the expression levels of PD-1 and PD-L1 in esophageal carcinoma tissue. The percentages of CD3^＋, CD4^＋and CD8^＋cells were detected by flow cytometry. Patients were followed up and adverse reactions and survival were recorded. Results The disease control rate was higher in the study group than that of the control group (P<0.05). There were no significant differences in all indexes between the groups before treatment (P>0.05). After treatment, HMGB1 level, SCCA level, MVD, serum PD-1 level and tumor tissue high expression rate of PD-1 were all decreased in the two groups, while serum PD-L1 level, PD-L1 high expression rate and percentages of CD3^＋, CD4^＋ and CD8^＋cells were all increased (P<0.05). Except there was no significant difference in MVD between groups, the other indexes were significantly changed in the study group compared with the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The progression-free survival rate was higher in the study group than that of the control group (P<0.05). Conclusion Carrellizumab combined with albumin-bound paclitaxel in the treatment of locally advanced esophageal cancer can help control lesion progression and inhibit angiogenesis, with good safety.

Key words: esophageal neoplasms, microvascular density, albumin-bound paclitaxel, camrelizumab

中图分类号:

R735.1

图/表 8

参考文献 23

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组别		n	性别（男/女）		年龄/ 岁	BMI/ （kg/m²）			疾病分型（鳞癌/腺癌）
对照组		49	23/26		60.20±5.81	23.29±1.17			35/14
研究组		49	27/22		59.60±5.64	23.16±1.39			33/16
t或χ²			0.653		0.529	0.537			0.192
组别	分期（Ⅲ期/Ⅳ期）			肿瘤直径/ cm			肿瘤位置
组别	分期（Ⅲ期/Ⅳ期）			肿瘤直径/ cm			颈段	上段		中段	下段
对照组	30/19			8.22±1.69			13	11		16	9
研究组	34/15			8.39±1.44			8	15		14	12
t或χ²	0.721			0.515			2.368

组别		n	性别（男/女）		年龄/ 岁	BMI/ （kg/m²）			疾病分型（鳞癌/腺癌）
对照组		49	23/26		60.20±5.81	23.29±1.17			35/14
研究组		49	27/22		59.60±5.64	23.16±1.39			33/16
t或χ²			0.653		0.529	0.537			0.192
组别	分期（Ⅲ期/Ⅳ期）			肿瘤直径/ cm			肿瘤位置
组别	分期（Ⅲ期/Ⅳ期）			肿瘤直径/ cm			颈段	上段		中段	下段
对照组	30/19			8.22±1.69			13	11		16	9
研究组	34/15			8.39±1.44			8	15		14	12
t或χ²	0.721			0.515			2.368

组别	n	CR	PR	SD	PD	疾病控制
对照组	49	9（18.37）	20（40.82）	8（16.33）	12（24.49）	37（75.51）
研究组	49	15（30.61）	19（38.78）	11（22.45）	4（8.16）	45（91.84）

组别	n	CR	PR	SD	PD	疾病控制
对照组	49	9（18.37）	20（40.82）	8（16.33）	12（24.49）	37（75.51）
研究组	49	15（30.61）	19（38.78）	11（22.45）	4（8.16）	45（91.84）

组别	HMGB1/（μg/L）			SCCA/（μg/L）			MVD/（个/视野）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	257.54±30.88	126.92±22.43	26.692^＊	6.16±1.27	5.41±1.29	2.742^＊	15.82±3.10	13.53±2.61	3.604^＊
研究组	255.62±32.67	98.51±19.32	25.784^＊	6.14±1.26	3.37±0.84	12.683^＊	15.67±2.39	13.39±2.14	5.409^＊
t	0.297	6.718^＊		0.078	9.198^＊		0.255	0.297