PD-1抑制剂联合化疗对非小细胞肺癌患者的临床疗效观察

Effects of PD-1 inhibitor combined with chemotherapy on the clinical effectiveness of patients with non-small cell lung cancer

目的评估Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)患者经结合程序性死亡受体(PD-1)抑制剂治疗后的肺功能相关指标及疗效变化。方法选取2019年7月—2021年3月于我徐州医科大学附属医院治疗的NSCLC患者共80例,收集临床资料进行分析。根据治疗方式不同将上述患者分为2组:对照组(n=41)和观察组(n=39)。对照组采用AP或TP化疗方案,观察组采用化疗联合PD-1抑制剂治疗,2组均为一线治疗。治疗4个周期后,比较2组患者肺功能指标和T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)水平,肺癌相关肿瘤标志物水平和治疗效果。记录2组患者毒副反应发生情况。结果治疗后,观察组客观缓解率(ORR)为38.46%,对照组ORR为9.76%,差异有统计学意义(P<0.05)。治疗后观察组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC及一氧化碳弥散功能(DLCO)较治疗前显著改善,且优于对照组(P<0.05);肿瘤标志物血清细胞角蛋白19片段抗原(CYFRA21-1)、鳞状细胞癌抗原(SCCA)、糖链抗原(CA125)水平较治疗前显著下降(P<0.05);CD3^(+)和CD4^(+)水平较治疗前显著升高(P<0.05)。结论Ⅲ、Ⅳ期NSCLC患者经PD-1抑制剂治疗后肺功能和疗效显著,安全性好,可在临床上推广使用。

Objective To analyze the changes in pulmonary function and clinical effectiveness of patients with stageⅢandⅣnon-small cell lung cancer(NSCLC)after treatment with PD-1 inhibitor.Methods A total of 80 NSCLC patients who were treated in the Affiliated Hospital of Xuzhou Medical University from July 2019 to March 2021 were enrolled,and their clinical data were analyzed.Depending on different treatments,they were randomly divided into two groups:a control group(n=41)and an observation group(n=39).The control group received AP or TP chemotherapy,while the observation group underwent chemotherapy combined with PD-1 inhibitor.Both groups were subjected to first-line treatment.After four treatment cycles,both groups were compared for pulmonary function,T lymphocyte subsets(CD3^(+),CD4^(+),and CD8^(+)),the levels of tumor markers in lung tumor and clinical effectiveness.Their toxic and side effects were also recorded.Results After treatment,the objective response rate(ORR)was 38.46%for the observation group,and 9.76%for the control group,which were statistically different(P<0.05).After treatment,the observation group presented remarkable improvement in forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC and carbon monoxide diffusion function(DLCO),compared with those before treatment;these changes were also superior to those in the control group(P<0.05).Furthermore,the observation group showed significant decreases in the levels of serum cytokeratin 19 fragment antibody(CYFRA21-1),squamous cell carcinoma antigen(SCCA)and carbohydrate antigen(CA125)(P<0.05)as well as increases in the levels of CD3^(+)and CD4^(+),compared with those before treatment.Conclusions Treatment with PD-1 inhibitor can result in remarkably improved pulmonary function and clinical effectiveness in NSCLC patients at stageⅢandⅣ,with good safety.