不同免疫检查点抑制剂联合化疗治疗非小细胞肺癌的疗效及对肿瘤标志物水平的影响

Efficacy of different immune checkpoint inhibitors combined with chemotherapy for non-small cell lung cancer and the effects on tumor markers

目的 探讨不同免疫检查点抑制剂联合化疗治疗非小细胞肺癌的疗效及对肿瘤标志物水平的影响。方法 选取2019年3月至2021年12月间徐州医科大学附属徐州市立医院收治的148例非小细胞肺癌患者,根据治疗方法不同分为A组41例、B组35例、C组42例和D组30例。A组患者在常规化疗的基础上采用卡瑞利珠单抗治疗,B组患者联合替雷利珠单抗治疗,C组患者联合信迪利单抗治疗,D组患者采用单纯化疗治疗,比较四组患者的治疗效果、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、胸苷激酶1(TK1)水平、KPS评分及不良反应。结果 A、B、C三组患者治疗效果比较,差异无统计学意义(P>0.05);三组患者的治疗效果均高于D组,差异均有统计学意义(均P<0.05)。治疗后,A、B、C三组患者的CEA、CYFRA21-1和TK1水平比较,差异无统计学意义(P>0.05),但三组均低于D组,差异均有统计学意义(均P<0.05)。治疗后,四组患者的KPS评分均升高,且A、B、C三组患者的KPS评分均高于D组,差异均有统计学意义(均P<0.05)。四组患者治疗期间均出现口腔黏膜炎、手足麻木、白细胞降低及血小板下降、恶心呕吐和肝功能异常,但差异无统计学意义(P>0.05)。A、B、C三组Ⅰ~Ⅱ级甲状腺功能减退高于D组,A组出现Ⅰ~Ⅱ级反应性皮肤毛细血管增生症18例,Ⅲ~Ⅳ级8例,B、C、D三组未出现,差异均有统计学意义(均P<0.05)。结论 非小细胞肺癌患者采用免疫检查点抑制剂联合化疗治疗,患者的CEA、CYFRA21-1和TK1水平均降低,治疗效果较好。

Objective To study the efficacy of different immune checkpoint inhibitors combined with chemotherapy in the treatment of non-small cell lung cancer and its effects on the levels of tumor markers. Methods In this study, 148 patients with non-small cell lung cancer diagnosed and treated at Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University were selected from March 2019 to December. On the basis of therapies, they were categorized into group A(41 patients), group B(35 patients), group C(42 patients) and group D(30 patients). Group A received conventional chemotherapy plus camrelizumab. Group B received conventional chemotherapy plus tislelizumab. Group C received conventional chemotherapy plus sintilimab. Group D 30 received chemotherapy alone. The treatment effect, carcinoembryonic antigen(CEA), cytokeratin-19 fragment(CYFRA 21-1) and thymidine kinase 1(TK1) level, Karnofsky performance status(KPS) score and adverse reactions were compared among the four groups. Results There was no statistical significance in the therapeutic effect among group A, B and C(P>0.05). However, the therapeutic effect of group A, B and C was higher than that of group D(all P<0.05). After treatment, there was no statistical significance in the levels of CEA, CyFRA21-1 and TK1 among group A, B and C3(P>0.05), but the levels of CEA, CyFRA21-1 and TK1 were lower in the above three groups than those in group D(all P<0.05). KPS score increased significantly in the four groups. KPS score significantly higher in groups A, B and C3 was than in group D(all P<0.05). There was no statistical significance in oral mucositis, numbness in hands and feet, leukopenia, thrombocytopenia, nausea, vomiting and liver dysfunction among the four groups during treatment(P>0.05). The incidence of grade Ⅰ to Ⅱ hypothyroidism was higher in group A, B and C than in group D(all P<0.05). Grade Ⅰ to Ⅱ reactive cutaneous capillary endothelial proliferation occurred in 18 patients and grade Ⅲ to Ⅳ reactive cutaneous capillary endothelial proliferation occurred in 8 patients in group A and none in the remian three groups(all P<0.05). Conclusion Immune checkpoint inhibitors combined with chemotherapy is significant effective in the treatment of non-small cell lung cancer. The levels of CEA, CYFRA21-1 and TK1 are significantly reduced in patients with non-small cell lung cancer.