新辅助免疫联合化疗治疗食管鳞癌敏感性的相关因素分析

Analysis on related factors of sensitivity in neoadjuvant immunotherapy combined with chemotherapy for treating esophageal squamous cell carcinoma

目的探讨影响食管鳞癌新辅助免疫联合化疗治疗敏感性的相关因素。方法回顾性分析51例食管鳞癌患者的临床资料,根据治疗效果,将51例患者分为新辅助免疫联合化疗治疗敏感组(29例)和耐药组(22例)。采用统计学方法,分析影响新辅助免疫联合化疗治疗食管鳞癌敏感性影响因素。结果单因素分析结果显示,敏感组和耐药组治疗后CT测算病灶深度比较,差异有统计学意义(P<0.001)。治疗前后病灶深度差比较,差异有统计学意义(P=0.002)。敏感组内镜评估病理缓解患者占比较高,与耐药组比较差异有统计学意义(P<0.001)。多因素分析结果显示,内镜评估病理缓解程度(P=0.042,95%CI:1.096~161.519)和病理淋巴结转移(P=0.025,95%CI:0.003~0.670)是新辅助免疫联合化疗治疗食管鳞癌敏感性的独立影响因素。同时,CT测算的病灶浸润深度差≥0.750 cm的患者对新辅助免疫联合化疗更敏感(AUC=0.750,灵敏度为41.4%,特异度为55.0%,P=0.002,95%CI:0.618~0.882)。结论术前胸部CT测算病灶深度及内镜评估病理缓解程度可预测食管鳞癌患者对新辅助免疫联合化疗的敏感性,为制订治疗方案提供参考,但需扩大样本量深入研究各影响因素。

Objective To explore the related factors affecting the sensitivity of neoadjuvant immunotherapy combined with chemotherapy for treating esophageal squamous cell carcinoma(ESCC).Methods The clinical data of 51 cases of ESCC were retrospectively analyzed.The patients were divided into the neoadjuvant immunotherapy combined with chemotherapy sensitivity group(n=29)and resistance group(n=22)according to the treatment effects.The statistical methods were employed to analyze the factors affecting the sensitivity of neoadjuvant immunotherapy combined with chemotherapy for treating ESCC.Results The univariate analysis results showed that the lesion depth detected by CT after treatment had statistical difference between the sensitivity group and resistance group(P<0.001).The lesion depth also had statistical difference before and after treatment(P=0.002).The endoscopic evaluation showed that the proportion of the patients with pathological remission in the sensitivity group was higher than that in the resistance group with statistical difference(P<0.001).The multivariate analysis results showed that degree of pathological remission(P=0.042,95%CI:1.096-161.519)and pathological lymph node metastasis(P=0.025,95%CI:0.003-0.670)evaluated by endoscopy were the independent influencing factors of the sensitivity to neoadjuvant immunotherapy combined with chemotherapy.Meanwhile,the patients with tumor infiltration depth difference≥0.750 cm measured by CT were more sensitive to the immunotherapy combined with chemotherapy(AUC=0.750,sensitivity 41.4%,specificity 55.0%,P=0.002,95%CI:0.618-0.882).Conclusion Preoperative chest CT calculation of lesion depth and endoscopic assessment of pathological remission degree could predict the sensitivity of ESCC patients to neoadjuvant immunotherapy combined with chemotherapy,which provides reference for formulating the treatment regimen,however,it is necessary to enlarge the sample size and further study the various influencing factors.