纳武利尤单抗联合化疗对晚期胃癌患者免疫功能及预后的影响

The effect of nivolumab combined with chemotherapy on immune function and prognosis in patients with advanced gastric cancer

目的探讨纳武利尤单抗联合化疗对晚期胃癌患者免疫功能及预后的影响。方法选择2021年8月至2022年7月甘肃省肿瘤医院收治的晚期胃癌患者,按1∶1分为观察组和对照组。对照组采取单纯化疗,观察组在化疗基础上给予纳武利尤单抗。比较治疗前后两组患者免疫功能变化、肿瘤标志物水平;观察两组生活质量及不良反应发生情况。结果共纳入患者106例,观察组与对照组各53例。治疗后,两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平降低,CD8^(+)升高;观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)(39.16%±3.82%、26.05%±3.23%、0.89±0.21)高于对照组(33.92%±3.84%、21.98%±3.16%、0.62±0.13),CD8^(+)(29.24%±3.49%)低于对照(34.02%±3.13%)(P<0.05);治疗后,两组癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125CA125)水平下降,观察组[(2.15±0.65)mmol/L、(7.37±1.08)mmol/L、(6.36±0.89)ng/L]比对照组[(3.01±0.83)mmol/L、(10.43±2.15)mmol/L、(9.87±1.56)ng/L]更明显(P<0.05);观察组患者生活质量、客观缓解率(66.0%)、疾病控制率(79.2%)高于对照组(32.1%,49.1%),不良反应总发生率(18.9%)低于对照组(50.9%),差异均有统计学意义(P<0.05)。结论对晚期胃癌患者给予纳武利尤单抗联合化疗可以改善晚期胃癌患者免疫功能,降低血清肿瘤标志物水平及不良反应发生率,提高患者生活质量。

Objective To explore the effects of nivolumab combined with chemotherapy on immune function and prognosis in patients with advanced gastric cancer.Methods Patients with advanced gastric cancer admitted to Gansu Cancer Hospital from August 2021 to July 2022 were selected and divided into an observation group and a control group in a 1∶1 ratio.The control group received chemotherapy alone,while the observation group was given nivolumab combined with chemotherapy.The changes in immune function,tumor marker levels,quality of life,and adverse reactions were compared between the two groups before and after treatment.Results A total of 106 patients were included,with 53 in each group.After treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)decreased,while CD8^(+)increased in both groups;however,the observation group had higher levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)[(39.16%±3.82%,26.05%±3.23%,0.89±0.21)]than those in the control group[(33.92%±3.84%,21.98%±3.16%,0.62±0.13)],and lower CD8^(+)(29.24%±3.49%)compared to the control group(34.02%±3.13%)(P<0.05);after treatment,the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),and carbohydrate antigen 125(CA125)decreased more significantly in the observation group[(2.15±0.65)mmol/L,(7.37±1.08)mmol/L,(6.36±0.89)ng/L]than those in the control group[(3.01±0.83)mmol/L,(10.43±2.15)mmol/L,(9.87±1.56)ng/L](P<0.05);the observation group had better quality of life,objective remission rate(66.0%),and disease control rate(79.2%)compared to the control group(32.1%,49.1%),and a lower overall adverse reaction rate(18.9%)than those in the control group(50.9%),with all differences being statistically significant(P<0.05).Conclusion The combination of nivolumab and chemotherapy can improve the immune function of patients with advanced gastric cancer,reduce the levels of serum tumor marker and adverse reactions,and improve the quality of life.