125I粒子植入联合PD-1单抗治疗Ⅳ期非小细胞肺癌的疗效

Efficacy of 125I seed implantation combined with PD-1 monoclonal antibody in treatment of stage IV non-small cell lung cancer

目的:探究125I粒子植入联合程序性死亡因子(PD-1)单抗治疗Ⅳ期非小细胞肺癌患者的疗效。方法:回顾性分析2017年2月至2020年1月在解放军总医院第六医学中心放射诊断科就诊的106例Ⅳ期非小细胞肺癌患者资料。根据治疗方法,将患者分为联合组、放疗组、免疫治疗组。三组均给予常规化疗,在此基础上,联合组给予125I粒子植入联合PD-1单抗治疗,放疗组给予125I粒子植入治疗,免疫治疗组给予PD-1单抗治疗。分析三组患者一般资料、肿瘤最长径、疗效、无进展生存(PFS)、安全性等指标差异,组间比较采用单因素方差分析,治疗前后比较采用配对样本t检验,用Kaplan-Meier法计算生存率,用log-rank检验比较生存差异。结果:治疗后,三组的肿瘤最长径均减小,且联合组小于放疗组、免疫治疗组(F=4.70,P=0.011);联合组客观缓解率(ORR)、疾病控制率(DCR)、PFS率高于放疗组、免疫治疗组(χ^(2)=18.93,P<0.001;χ^(2)=11.11,P=0.004;χ^(2)=6.67,P=0.036),且免疫放疗组ORR高于放疗组(χ^(2)=4.23,P=0.040);三组不良反应发生情况比较差异无统计学意义(χ^(2)=1.60,P=0.449)。结论:125I粒子植入联合PD-1单抗治疗对Ⅳ期非小细胞肺癌患者可能有较好的疗效,能够缓解临床症状、提高远期生存率,安全性良好。

Objective To investigate the efficacy of 125I seed implantation combined with programmed cell death 1(PD-1)monoclonal antibody in the treatment of patients with stageⅣnon-small cell lung cancer.Methods A retrospective analysis was performed on 106 patients with stageⅣnon-small cell lung cancer treated in Department of Radiology of the Sixth Medical Center of PLA General Hospital from February 2017 to January 2020.All patients were divided into the combination group,radiotherapy group and immunotherapy group according to treatment methods.Besides conventional chemotherapy in all three groups,125I seed implantation combined with PD-1 monoclonal antibody therapy was given in the combination group,125I seed implantation therapy was delivered in the radiotherapy,and PD-1 monoclonal antibody therapy was supplemented in the immunotherapy group,respectively.Differences in the general data,maximum tumor diameter,efficacy,progression-free survival(PFS)and safety among the three groups were analyzed.One-way ANOVA was used for comparison between groups,paired sample t-test was used for comparison before and after treatment.Kaplan-Meier method was used to calculate the survival rate,and log-rank test was used to compare the survival curve.Results After treatment,the maximum tumor diameter in the three groups was decreased,and the data in the combination group was smaller than those in the radiotherapy and immunotherapy groups(F=4.67,P=0.011).The objective response rate(ORR),disease control rate(DCR)and PFS rate in the combination group were higher than those in the radiotherapy and immunotherapy groups(χ^(2)=18.93,P<0.001;χ^(2)=11.11,P=0.004;χ^(2)=6.67,P=0.036),and the ORR in the immunoradiotherapy group was higher than that in the radiotherapy group(χ^(2)=4.23,P=0.040).There was no significant difference in the occurrence of adverse reactions among the three groups(χ^(2)=1.60,P=0.449).Conclusion 125I seed implantation combined with PD-1 monoclonal antibody may yield high efficacy in patients with stageⅣnon-small cell lung cancer,which can alleviate clinical symptoms and improve long-term survival rate with good safety.