鼻咽癌颈部转移淋巴结基于PD-1检查点阻断原理放疗前后超声变化规律

Ultrasonic changes of cervical lymph node metastasis before and after radiotherapy based on PD-1 checkpoint blocking principle in nasopharyngeal carcinoma

目的研究鼻咽癌(NPC)患者颈部淋巴结在放疗前后的超声变化规律,探讨PD-1在NPC患者治疗过程中的作用及单克隆抗体在放射治疗NPC中的应用。方法通过免疫组织化学染色技术判断PD-1的表达,分析NPC组织中PD-1表达与临床病理参数的关系。分别对PD-1表达阴性和阳性的NPC患者应用彩色多普勒超声检查,同时对普通放疗组(对照组)和加入单克隆抗体治疗组(实验组)在放疗前后的颈部淋巴结转移灶的长径(L)、短径(S)、长径/短径(L/S)、收缩期峰值流速(PSV)、阻力指数(RI)、血流强度进行对比观察。结果 PD-1阴性患者及阳性患者的实验组和对照组的L、S、PSV和RI指标在放疗4周后均呈现下降趋势,而L/S则呈现升高趋势;治疗4周后PD-1阳性患者的实验组各项超声指标较对照组变化程度明显增加;血流强度检测中,PD-1阳性患者的实验组在治疗4周后实验组0级较对照组比例高,而Ⅱ级较对照组比例小。结论 PD-1在NPC治疗过程中起着重要的作用,传统放射治疗方法加入单克隆抗体后可以有效提高疗效。

Objective To investigate the ultrasound changes of cervical lymph nodes in patients with nasopharyngeal carcinoma(NPC) before and after radiotherapy, and to explore the role of PD-1 in the treatment of NPC patients and the application of monoclonal antibodies in radiotherapy of NPC. Methods The expression of PD-1 was determined by immunohistochemical staining technique, and the relationship between PD-1 expression and clinicopathological parameters in NPC tissues was analyzed. Color Doppler ultrasonography was performed on NPC patients with negative and positive PD-1 expression, and the long diameter (L), short diameter (S), long diameter/short diameter (L/S), peak systolic velocity (PSV), resistance index (RI), and blood flow intensity of the cervical lymph node metastases before and after radiotherapy were compared between the general radiotherapy group (control group) and the monoclonal antibody-treated group (experimental group). Results The L, S, PSV and RI indexes of PD-1 negative patients and PD-1 positive patients in the experimental group and the control group all showed a downward trend after 4 weeks of radiotherapy, while L/S showed an increasing trend. After 4 weeks of treatment, the ultrasound indexes of the PD-1 positive patients in the experimental group were significantly increased compared with those of the control group. In the blood flow intensity test, the proportion of grade 0 in the experimental group of PD-1 positive patients was higher than that in the control group after 4 weeks of treatment, and the proportion of grade Ⅱ was lower than that of the control group. Conclusion PD-1 plays an important role in the treatment of NPC. The efficacy of traditional radiotherapy can be effectively improved after adding monoclonal antibodies.