调强放疗联合免疫治疗对食管鳞状细胞癌患者的效果

Effect of Intensity Modulated Radiotherapy Combined with Immunotherapy on Patients with Esophageal Squamous Cell Carcinoma

目的 探讨调强放疗联合树突状细胞-细胞因子诱导的杀伤细胞(DC-CIK)治疗食管鳞状细胞癌(ESCC)的临床效果,分析其对患者肿瘤标志物、生活质量及免疫功能的影响。方法 选取2019年4月至2022年6月安阳市肿瘤医院收治的205例ESCC患者为研究对象,依据其治疗意愿分为单一组(98例)、联合组(107例)。单一组接受调强放疗,联合组接受调强放疗联合DC-CIK治疗。对比两组临床疗效、不良反应、生活质量评分(EORTC QLQ-OES18)。比较两组治疗前后肿瘤标志物[癌胚抗原(CEA)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCCA)]水平、免疫功能(CD3^(+)、CD4^(+)、NK细胞)、血管生长因子[血管内皮生长因子(VEGF)、表皮生长因子受体(EGFR)、转化生长因子-β_(1)(TGF-β_(1))]水平及微小RNA-137(miR-137)、微小RNA-155(miR-155)表达量。结果 联合组客观缓释率(49.53%)高于单一组(25.51%)(P<0.05);治疗后联合组血清CEA、CYFRA21-1、SCCA、VEGF、EGFR、TGF-β_1水平低于单一组,miR-137、miR-155表达量及EORTC QLQ-OES18评分低于单一组(P<0.05);治疗后联合组CD3^(+)、CD4^(+)、NK细胞高于单一组(P<0.05);联合组不良反应发生率与单一组比较差异无统计学意义(P>0.05)。结论 调强放疗联合DC-CIK治疗ESCC效果确切,可降低患者肿瘤标志物表达水平,抑制肿瘤血管生长,改善免疫功能,提高生活质量,且具有一定安全性。

Objective To investigate the clinical efficacy of intensity-modulated radiotherapy combined with dendritic cell-cytokine-induced killer cells(DC-CIK)for esophageal squamous cell carcinoma(ESCC),and to analyze its effects on tumor markers,quality of life and immune function in patients.Methods A total of 205 patients with ESCC admitted to Anyang Cancer Hospital from April 2019 to June 2022 were selected for the study,and were divided into single group(98 cases)and combined group(107 cases)according to their treatment willingness.The single group was treated with intensity-modulated radiotherapy and the combined group was treated with intensity-modulated radiotherapy combined with DC-CIK.The clinical efficacy,toxic side effects and quality of life scores(EORTC QLQ-OES18)of the two groups were compared.The levels of tumor markers[carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),squamous epithelial cell carcinoma antigen(SCCA)],immune function(CD3^(+),CD4^(+),NK cells),vascular growth factors[vascular endothelial growth factor(VEGF),epidermal growth factor receptor(EGFR),transforming growth factor-β_(1)(TGF-β_(1))]and expression of microRNA-137(miR-137)and microRNA-155(miR-155)were compared before and after treatment in both groups.Results The objective slow release rate in the combined group(49.53%)was higher than the single group(25.51%)(P<0.05).The serum CEA,CYFRA21-1,SCCA,VEGF,EGFR,TGF-β_(1) levels were lower in the combined group than in the single group after treatment,and miR-137,miR-155 expression and EORTC QLQ-OES18 scores were lower than in the single group(P<0.05).The CD3^(+),CD4^(+),and NK cells were higher in the combined group than in the single group after treatment(P<0.05).The difference in the incidence of toxic side effects in the combined group compared with the single group was not statistically significant(P>0.05).Conclusion The combination of intensity modulated radiation therapy and DC-CIK has a definite effect on ESCC,which can reduce the expression level of tumor markers in patients,inhibit tumor vascular growth,improve immune function,improve quality of life,and has certain safety.