摘要
目的探讨免疫治疗联合化疗对Ⅲ-Ⅳ期食管鳞状细胞癌(ESCC)的治疗效果和相关预后因素。方法回顾性收集2019-01-01-2021-05-31徐州医科大学附属医院免疫抑制剂联合化疗治疗Ⅲ~Ⅳ期116例ESCC患者的临床病历资料。采用生存分析评估治疗效果。同时纳入中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、全身炎症指数(SII)、预后营养指数(PNI)和淋巴细胞单核细胞比值(LMR),通过受试者工作特征分析获取最佳截断值,并以该截断值分组。以多变量Cox比例风险模型分析影响患者生存的预后因素。结果共纳入116例免疫治疗Ⅲ~Ⅳ期ESCC患者,中位随访时间为501 d(95%CI为523~591 d)。其中接受卡瑞丽珠单抗治疗81例,替雷利珠单抗13例,信迪利单抗22例。所有患者均接受了≥2次治疗,既往治疗的中位数为1次,ECOG PS Score中位数为0。在数据截断日期,中位总生存期为493 d,1年的总生存率为56%。多变量Cox比例风险模型结果显示,只有SII(HR=2.73,95%CI为1.04~7.20,P=0.042)和PNI(HR=0.32,95%CI为0.12~0.86,P=0.024)是独立的预后因素。Kaplan-Meier分析显示,高SII和低PNI组更容易发生死亡,总体log-rank=19.345,P<0.001。结论PD-1抑制剂联合化疗在Ⅲ~Ⅳ期ESCC患者中观察到了生存期的显著延长,即使既往多线治疗,无机会行手术的患者也可能从中获益。SII、PNI指标可独立预测免疫治疗的预后,二者联合可能有助于患者分层。
Objective To investigate the therapeutic effects and prognostic factors associated with immunotherapy combined with chemotherapy in stage Ⅲ-Ⅳ esophageal squamous cell carcinoma(ESCC).Methods Clinicopathological data of patients with stage Ⅲ-Ⅳ ESCC treated with immunosuppressant combined with chemotherapy from 2019-01-01 to 2021-05-31 at Affiliated Hospital of Xuzhou Medical University were retrospectively collected.Survival analysis was used to assess treatment outcomes. Neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR), systemic inflammation index(SII), prognostic nutritional index(PNI) and lymphocyte monocyte ratio(LMR) were included, and the best cut-off value was obtained through receiver operating characteristic(ROC) analysis and grouped by that cut-off value.Multivariate Cox proportional hazards model was used to analyze the prognostic factors affecting patient survival.Results A total of 116 immunotherapy patients with stage Ⅲ-Ⅳ ESCC were enrolled with a median follow-up time of 501 d(95%CI:523-591 d),of which 81 received camrelizumab, 13 received tislelizumab, and 22 received sintilimab. All patients received ≥2 treatments with a median previous treatment of once and a median ECOG PS Score of 0.At the date of data cutoff, the median overall survival was 493 days, and the 1-year overall survival rate was 56%. Multivariate Cox proportional hazards model showed that only SII(HR=2.73;95%CI:1.04-7.20;P=0.042) and PNI(HR=0.32;95%CI:0.12-0.86;P=0.024) were independent prognostic factors. The Kaplan-Meier analysis showed that high SII and low PNI were more prone to death(overall log-rank=19.345,P<0.001).Conclusions Anti-PD-1 combined with chemotherapy has been observed to significantly prolong survival in patients withⅢ-Ⅳstage ESCC,even if the patients who have not had the opportunity to undergo surgery may benefit from the previous multiline therapy.SII and PNI can independently predict the prognosis of immunotherapy,and the combination of them may help to stratify patients.
作者
刘淑君
苗浩
王颖
谢宁
童方琴
刘桂红
LIU Shujun;MIAO Hao;WANG Ying;XIE Ning;TONG Fangqin;LIU Guihong(Affiliated Hospital of Xuzhou Medical University,Xuzhou 2210o0,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2023年第7期406-411,429,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
上海防癌抗癌探索科研基金。
关键词
食管鳞状细胞癌
预后
预后营养指标
全身免疫炎症指数
免疫治疗
esophageal squamous cell carcinoma
prognosis
prognostic nutritional index
systemic immune inflammation index
immunotherapy
