特瑞普利单抗联合放化疗对鼻咽癌颈部淋巴结转移患者PTX3、CYFRA21-1水平的影响

Clinical efficacy of Triprilimab combined with chemoradiotherapy in the treatment of nasopharyngeal carcinoma with cervical lymph node metastasis and its effect on PTX3 and CYFRA21-1 levels

目的 探讨特瑞普利单抗联合放化疗治疗鼻咽癌颈部淋巴结转移患者的临床疗效及对正五聚蛋白3(PTX3)、细胞角蛋白19片段抗原21-1(CYFRA21-1)水平的影响。方法 选取2021年6月至2022年6月中国人民解放军西部战区总医院肿瘤科鼻咽癌颈部淋巴结转移患者95例,按随机数字表法分为观察组(48例)、对照组(47例)。对照组常规进行放化疗治疗,在对照组基础上观察组加用特瑞普利单抗,均治疗3个疗程。对比两组疗效及治疗前后检测血清PTX3、CYFRA21-1、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)及T淋巴细胞水平。统计两组治疗期间不良反应发生率。随访至2023年3月31日统计两组无进展生存时间(PFS)。结果 观察组鼻咽部原发灶及颈部淋巴结客观缓解率(ORR)高于对照组(P<0.05)。治疗后两组血清PTX3、CYFRA21-1水平低于治疗前,且观察组低于对照组(P<0.05)。治疗后观察组血清IFN-γ、TNF-α水平高于治疗前,且观察组高于对照组(P<0.05)。治疗后观察组CD3^(+)、CD4^(+)、CD8^(+)高于治疗前,且高于对照组(P<0.05)。两组胃肠道反应、口腔黏膜炎、放射性皮炎、白细胞下降、中性粒细胞下降、血小板下降、肝肾功能损伤、疲劳、贫血发生率比较,差异无统计学意义(P>0.05)。血清PTX3、CYFRA21-1高水平患者PFS短于低水平患者(P<0.05)。结论 特瑞普利单抗联合放化疗治疗鼻咽癌颈部淋巴结转移患者的临床疗效显著,可有效降低血清PTX3、CYFRA21-1水平,提升IFN-γ、TNF-α及T淋巴细胞水平,且安全性有保障。

ObjectiveTo evaluate the clinical efficacy of triprilimab combined with chemoradiotherapy in patients with nasopharyngeal carcinoma and cervical lymph node metastasis and its impact on the levels of pentraxin 3(PTX3)and cytokeratin 19 fragment antigen 21-1(CYFRA21-1).Methods A total of 95 patients with nasopharyngeal carcinoma and cervical lymph node metastasis treated at the Cancer Department of the Western Theater General Hospital of the People′s Liberation Army from June 2021 to June 2022 were selected.They were randomly divided into an observation group(48 cases)and a control group(47 cases).The control group received routine chemoradiotherapy,while the observation group received additional triprilimab,with both groups undergoing three cycles of treatment.The efficacy of the two groups was compared,and serum levels of PTX3,CYFRA21-1,interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),and T lymphocyte levels were measured before and after treatment.The incidence of adverse events during treatment was also recorded.Progression-free survival(PFS)was assessed through follow-up until March 31,2023.Results The objective response rate(ORR)of the nasopharyngeal primary lesion and cervical lymph nodes in the observation group was higher than that in the control group(P<0.05).After treatment,the serum levels of PTX3 and CYFRA21-1 in both groups decreased compared to before treatment,and the observation group was lower than the control group(P<0.05).Post-treatment,the observation group showed higher serum levels of IFN-γ,TNF-α,CD3^(+),CD4^(+),and CD8^(+)compared to pre-treatment,and these levels were higher than those in the control group(P<0.05).There were no statistically significant differences in the incidence of gastrointestinal reactions,oral mucositis,radiation dermatitis,leukopenia,neutropenia,thrombocytopenia,liver and kidney function damage,fatigue,and anemia between the two groups(P>0.05).Patients with high levels of serum PTX3 and CYFRA21-1 had a shorter PFS than those with low levels(P<0.05).Conclusion Triprilimab combined with chemoradiotherapy demonstrates significant clinical efficacy in the treatment of nasopharyngeal carcinoma with cervical lymph node metastasis.This approach effectively reduces serum PTX3 and CYFRA21-1 levels,enhances IFN-γ,TNF-α,and T lymphocyte levels,and maintains a satisfactory safety profile.