帕博利珠单抗联合放化疗对晚期非小细胞肺癌患者的影响

Effect of pembrolizumab combined with radiotherapy and chemotherapy on patients with advanced non-small cell lung cancer

目的:探究帕博利珠单抗联合放化疗对晚期非小细胞肺癌(NSCLC)患者的影响。方法:回顾性分析112例晚期NSCLC患者的临床资料,根据治疗方案不同将患者分为放化疗组(给予三维适形放疗联合吉西他滨与顺铂化疗)与单抗组(在放化疗组基础上给予帕博利珠单抗治疗),21 d为1个疗程,持续4个疗程。所有患者进行倾向性匹配排除混杂因素,每组各56例。对比两组患者近期疗效、放疗敏感性、随访1年生存情况,治疗前后肿瘤标志物[血清癌胚抗原(CEA)、糖类抗原125(CA125)、转录因子SOX2(SOX2)]及药物毒副反应发生情况。结果:单抗组缓解率(53.57%)高于放疗组(33.93%)(P<0.05),而两组控制率无统计学差异(P>0.05);单抗组放疗敏感性高于放化疗组(P<0.05);两组均获得随访1年数据,单抗组无进展生存时间(PFS)为(9.55±3.34)个月,总生存时间(OS)为(11.65±1.42)个月,死亡5例;放化疗组患者PFS为(8.41±3.58)个月,总生存期为(10.93±2.24)个月,死亡13例,两组OS与PFS均有统计学差异(P<0.05);治疗后,两组患者CEA、CA125、SOX2水平均下降(P<0.05),且单抗组低于放化疗组(P<0.05);两组药物毒副反应总发生率无统计学差异(P>0.05)。结论:帕博利珠单抗联合放化疗可有效治疗晚期NSCLC,提高患者生存期与放疗敏感度,降低肿瘤标志物水平,安全性高,值得应用。

Objective:To explore the effect of pembrolizumab combined with radiotherapy and chemotherapy on patients with advanced non-small cell lung cancer(NSCLC).Methods:Retrospective analysis of 112 patients with advanced NSCLC.According to different treatment regimens,they were divided into chemoradiotherapy group(three-dimensional conformal radiotherapy combined with gemcitabine and cisplatin chemotherapy)and monoclonal antibody group(pembrolizumab on the basis of chemoradiotherapy).Both groups were treated for 4 courses with 21 days as one treatment course.Propensity matching was used to exclude confounding factors of all patients,with 56 cases in each group.The short-term efficacy,radiotherapy sensitivity,survival status after 1 year of follow-up,tumor markers[serum carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),transcription factor SOX2(SOX2)]before and after treatment and drug toxic and sude effects were compared between groups.Results:The response rate(RR)in monoclonal antibody group(53.57%)was higher than that in chemoradiotherapy group(33.93%)(P<0.05),there was no statistical significance in the disease control rate(DCR)between groups(P>0.05).The radiotherapy sensitivity in monoclonal antibody group was significantly higher than that in chemoradiotherapy group(P<0.05).1-year follow-up data were obtained in both groups.In monoclonal antibody group,PFS and overall survival(OS)were(9.55±3.34)months and(11.65±1.42)months,and 5 patients died.In chemoradiotherapy group,Progression free survival(PFS)and Overall Survival(OS)were(8.41±3.58)months and(10.93±2.24)months,and 13 patients died.There were significant differences in OS and PFS between groups(P<0.05).After treatment,the levels of CEA,CA125 and SOX2 in both groups were significantly decreased(P<0.05),and the levels in monoclonal antibody group were significantly lower than those in chemoradiotherapy group(P<0.05).There were no statistical differences in the incidence rates of drug toxic and side effects between chemoradiotherapy group and monoclonal antibody group(P>0.05).Conclusion:Pembrolizumab combined with chemoradiotherap can effectively treat advanced NSCLC,enhance the survival time and radiotherapy sensitivity,and reduce the levels of tumor markers,and it has high safety.It is worth of clinical application.