新辅助抗PD-1免疫治疗联合放化疗治疗局部晚期非小细胞肺癌的临床疗效

Clinical efficacy of neoadjuvant anti-PD-1 immunotherapy combined with chemoradiotherapy in the treatment of locally advanced non-small cell lung cancer

目的研究新辅助抗PD-1免疫疗法与化疗结合放疗序贯治疗方案治疗局部晚期非小细胞肺癌的临床疗效与安全性。方法回顾性选取2021年3月至2022年3月江苏省肿瘤医院治疗的非小细胞肺癌患者80例。依据治疗方案不同分为研究组和对照组,每组各40例。研究组接受含新辅助抗PD-1疗法的综合放化疗,对照组仅接受标准放化疗。比较两组患者的实体瘤治疗客观缓解率、细胞免疫功能、血清肿瘤因子[癌胚抗原(CEA)、糖类抗原(CA)125、CA199]以及不良反应。结果研究组患者治疗后的客观缓解率为7.00%,明显高于对照组(52.50%),差异有统计学意义(P<0.05)。治疗后,研究组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均较治疗前升高,对照组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均较治疗前降低,且研究组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)分别为(64.33±5.16)%、(43.71±4.53)%、(32.54±3.91)%、1.34±0.26,均明显高于对照组[(55.25±5.63)%、(31.87±3.16)%、(28.24±3.89)%、1.13±0.31],差异均有统计学意义(P<0.05)。治疗后,两组患者的血清CEA、CA125、CA199水平均较治疗前降低,且研究组患者的血清CEA、CA125、CA199水平分别为(12.25±4.15)ng/mL、(31.55±5.78)U/mL、(56.62±8.52)U/mL,均明显低于对照组[(18.97±4.36)ng/mL、(38.17±5.81)U/mL、(65.20±8.79)U/mL],差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论新辅助抗PD-1免疫治疗联合放化疗相比单纯放化疗对局部晚期非小细胞肺癌有更加明显的优势,能够提高放化疗过程中的机体免疫功能,减少血清肿瘤相关因子,同时没有增加明显的不良反应,可以作为非小细胞肺癌提升疗效的方案在临床中推广应用。

Objective To study the clinical efficacy and safety of a sequential treatment plan combining neoadjuvant anti-PD-1 immunotherapy with chemotherapy and radiotherapy in locally advanced non-small cell lung cancer.Methods Eighty patients with non-small cell lung cancer treated at Jiangsu Cancer Hospital from March 2021 to March 2022 were retrospectively selected.They were divided into the study group and the control group according to different treatment plans,with 40 cases in each group.The study group received comprehensive chemoradiotherapy with neoadjuvant anti-PD-1 therapy,and the control group only received standard chemoradiotherapy.The treatment efficiency of solid tumors,cellular immune function,serum tumor factors[carcinoembryonic antigen(CEA),carbohydrate antigen(CA)125,CA199],and toxic side effects in the two groups were compared.Results The objective response rate of patients in the study group was 7.00%,which was significantly higher than that in the control group(52.50%),and the difference was statistically significant(P<0.05).After treatment,the levels of CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)in the study group were higher than those before treatment,while the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the control group were lower than those before treatment,moreover,the levels of CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)in the study group after treatment were(64.33±5.16)%,(43.71±4.53)%,(32.54±3.91)%,and 1.34±0.26,respectively,which were significantly higher than those in the control group[(55.25±5.63)%,(31.87±3.16)%,(28.24±3.89)%,1.13±0.31],the differences were statistically significant(P<0.05).After treatment,the levels of serum CEA,CA125,and CA199 in both groups of patients were lower than those,and the levels of serum CEA,CA125,and CA199 in the study group were(12.25±4.15)ng/mL,(31.55±5.78)U/mL,and(56.62±8.52)U/mL,respectively,which were significantly lower than those in the control group[(18.97±4.36)ng/mL,(38.17±5.81)U/mL,and(65.20±8.79)U/mL],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Neoadjuvant anti-PD-1 immunotherapy combined with chemoradiotherapy has more obvious advantages than simple chemoradiotherapy in the treatment of locally advanced non-small cell lung cancer,which can improve the immune function of the body during chemoradiotherapy and reduce serum tumor-related factors without increasing obvious toxic and side effects,and can be promoted in clinical application as a program to improve the efficacy of non-small cell lung cancer.