信迪利单抗联合紫杉醇和顺铂方案治疗晚期食管癌患者的效果

Therapeutic efficacy of Sintilimab combined with paclitaxel/cisplatin regimen for advanced esophageal cancer

目的探讨紫杉醇+顺铂(TP)方案结合信迪利单抗在晚期食管癌治疗方面的效果及其对肿瘤标志物的影响。方法选取保山市人民医院2020年4月—2023年5月接受相应治疗的120例晚期食管癌患者,通过随机数字表法分为两组。对照组60例患者给予TP方案,联合组60例在对照组的基础上联合使用信迪利单抗。对比及分析两组患者临床疗效、功能状态、肿瘤标志物以及不良反应发生率。结果联合组的客观缓解率为51.67%(31/60),高于对照组的33.33%(20/60)(χ^(2)=4.126,P<0.05);联合组的疾病控制率为88.33%(53/60),高于对照组的63.33%(38/60)(χ^(2)=10.231,P<0.05)。治疗后,联合组和对照组患者卡氏功能状态表(KPS)评分[分别是(89.61±5.28)分、(82.97±6.21)分],高于治疗前[分别是(71.88±6.72)分、(71.41±6.01)分],且联合组患者的KPS评分高于对照组(P<0.05);治疗后,对照组与联合组患者血清鳞状细胞癌相关性抗原(SCC)、癌胚抗原(CEA)、血清细胞角质蛋白19片段抗原21-1(Cyfra21-1)水平[分别是(1.63±0.29)μg·L^(-1)、(21.61±3.78)ng·mL^(-1)、(7.19±0.93)μg·L^(-1)、(2.19±0.37)μg·L^(-1)、(26.87±3.21)ng·mL^(-1)、(8.62±1.16)μg·L^(-1)],均低于治疗前[分别是(3.59±0.76)μg·L^(-1)、(40.97±4.82)ng·mL^(-1)、(18.24±2.95)μg·L^(-1)、(3.76±0.81)μg·L^(-1)、(41.32±5.01)ng·mL^(-1)、(18.91±3.24)μg·L^(-1)],且联合组水平低于对照组(均P<0.05);在不良反应总发生率方面,对照组为51.67%(31/60),联合组为48.33%(29/60),两组比较差异无统计学意义(χ^(2)=1.493,P=0.222)。结论TP方案结合信迪利单抗治疗晚期食管癌患者的效果较高,能够下调患者肿瘤标志物SCC、CEA、Cyfra21-1在血清中的表达,改善患者功能状态,且安全性良好。

Objective To investigate the clinical efficacy of paclitaxel/cisplatin(TP)regimen combined with sintilimab in the treatment of advanced esophageal cancer and its impact on tumor markers.Methods A total of 120 patients with advanced esophageal cancer treated in our hospital from April 2020 to May 2023 were selected,and divided into two groups using random number table method,with 60 in each group.The patients in the control group were given TP regimen and those in the combined one neoadjuvant therapy with sintilimab on the basis of the treatment regimen in the control.The clinical efficacy,Karnofsky performance status(KPS),tumour markers and incidence of adverse reactions were compared between the 2 groups.Results The combined group reported a higher objective remission rate[51.67%(31/60)vs.33.33%(20/60),χ^(2)=4.126,P<0.05]and disease control rate[88.33%(53/60)vs.63.33%(38/60),χ^(2)=10.231,P<0.05]as compared with the control,showing statistical difference.After treatment,an increase in KAP scores was observed in the control group compared to baseline data[(82.97±6.21)scores vs.(71.41±6.01)scores]and the combined group[(89.61±5.28)scores vs.(71.88±6.72)scores],and combined group scored higher than the control,demonstrating statistical difference(P<0.05).Compared to baseline data,a reduction in squamous cell carcinoma antigen(SCC),carcinoembryonic antigen(CEA),and cytokeratin 19 fragment antigen 21-1(Cyfra21-1)was detected in the control group[(3.76±0.81)μg·L^(-1)vs.(2.19±0.37)μg·L^(-1),(41.32±5.01)ng·mL^(-1)vs.(26.87±3.21)ng·mL^(-1),(18.91±3.24)μg·L^(-1)vs.(8.62±1.16)μg·L^(-1)]and the combined group[(3.59±0.76)μg·L^(-1)vs.(1.63±0.29)μg·L^(-1),(40.97±4.82)ng·mL^(-1)vs.(21.61±3.78)ng·mL^(-1),(18.24±2.95)μg·L^(-1)vs.(7.19±0.93)μg·L^(-1)],and the reduction was more notable in the combined group than in the control,showing statistical difference(P<0.05).No statistical difference was found in overall adverse reaction rate between the 2 groups[51.67%(31/60)vs.48.33%(29/60),χ^(2)=1.493,P=0.222].Conclusion TP regimen combined with Sintilimab is highly effective in treating invalids with advanced esophageal cancer since it can down-regulate the expression of tumour markers SCC,CEA,Cyfra21-1 in serum and improve functional status,and has a good safety profile.