阿帕替尼联合艾瑞卡对NSCLC患者免疫细胞表面分子表达的影响

Effect of apatinib and Erica on the expression of immune cell surface molecules in patients with NSCLC

目的分析阿帕替尼联合艾瑞卡对非小细胞肺癌患者免疫细胞表面分子表达的影响,并免疫细胞表面分子与临床预后的相关性。方法采用巢式对照研究法,以确诊为晚期非小细胞肺癌为研究起点,将接受放化疗+阿帕替尼靶向治疗的病例作为阿帕替尼组35例,将与阿帕替尼组基线资料相匹配的接受放化疗+阿帕替尼+艾瑞卡的病例作为阿帕艾瑞组30例。观察阿帕替尼组和阿帕艾瑞组临床预后情况(总生存月数)及血清免疫指标(CD4^(+)T细胞、Treg细胞及表面分子CD39^(+)、PD-1^(+))表达情况,并采用生存时间Kaplan-Meier曲线分析CD39、PD-1表达对临床预后的影响。结果阿帕艾瑞组平均总生存时间(8.57±1.34)个月长于阿帕替尼组(6.70±0.54)个月,P<0.05。与治疗前比较,治疗后阿帕替尼组和阿帕艾瑞组的CD4^(+)CD39^(+)、CD4^(+)PD-1^(+)表达水平均下降,但阿帕艾瑞组的CD4^(+)CD39^(+)、CD4^(+)PD-1^(+)表达水平下降幅度高于阿帕替尼组(P<0.05)。与治疗前比较,治疗后阿帕替尼组和阿帕艾瑞组的Treg^(+)CD39^(+)、Treg^(+)PD-1^(+)表达水平均下降,但阿帕艾瑞组的Treg^(+)CD39^(+)、Treg^(+)PD-1^(+)表达水平下降幅度高于阿帕替尼组(P<0.05)。CD39阳性表达病例的平均总生存时间(5.48±0.34)个月短于CD39阴性表达病例(9.61±1.28)个月(P<0.05)。PD-1阳性表达病例的平均总生存时间(5.44±0.28)个月短于PD-1阴性表达病例(9.89±1.19)个月(P<0.05)。结论与阿帕替尼辅助放化疗方案比较,阿帕替尼联合艾瑞卡辅助放化疗可获取到更佳总生存时间收益,可改善非小细胞肺癌患者免疫相关细胞CD39、PD-1蛋白的表达,可能与艾瑞卡的恢复机体抗肿瘤免疫力有关。

Objective To observe the effect of apatinib combined with Erica on the expression of immune cell surface molecules in patients with non-small cell lung cancer,and the correlation between immune cell surface molecules and clinical prognosis.Methods Using the nested control method,the patients with advanced non-small cell lung cancer were treated with radiotherapy and chemotherapy + apatinib targeted therapy as apatinib group(35 cases),and the patients with radiotherapy and chemotherapy^(+)apatinib + Arica matched with the baseline data of apatinib group as apairib group(30 cases).The clinical prognosis(total survival months)and the expression of serum immune indexes(CD4^(+)T cells,Treg cells and surface molecules CD4^(+),PD-1)were observed in apatinib group and apairi group.The influence of CD39 and PD-1 expression on the clinical prognosis was analyzed by the survival time Kaplan Meier curve.Results The mean total survival time of apairi group(8.57±1.34)months was longer than that of apatinib group(6.70±0.54)months(P<0.05).Compared with that before treatment,the expression levels of CD4^(+)CD39^(+)、CD4^(+)PD-1^(+)in apairinib group and apairinib group decreased after treatment,but the decrease of CD4^(+)CD39^(+),CD4^(+)PD-1^(+)in apairinib group was higher than that in apairinib group(P<0.05).Compared with that before treatment,Treg^(+)CD39^(+),Treg^(+)PD-1^(+)expression in apatinib group and apairib group decreased after treatment,but Treg^(+)CD39^(+),Treg^(+)PD-1^(+)expression in apairib group decreased more than that in apatinib group(P<0.05).The average total survival time of CD39 positive cases(5.48±0.34)months was shorter than that of CD39 negative cases(9.61±1.28)months(P<0.05).The mean total survival time of PD-1 positive cases(5.44±0.28)months was shorter than that of PD-1 negative cases(9.89±1.19)months(P<0.05).Conclusion Compared with apatinib adjuvant radiotherapy and chemotherapy,apatinib combined with Arica adjuvant radiotherapy and chemotherapy can obtain better total survival time benefits,improve the expression of CD39 and PD-1 protein in immune related cells of non-small cell lung cancer patients,which may be related to the recovery of anti-tumor immunity of Arica.