摘要
目的 探讨卡瑞利珠单抗联合化疗治疗晚期食管鳞状细胞癌的疗效及对血清癌胚抗原、鳞状细胞癌抗原(SCC)、血管内皮生长因子(VEGF)水平和免疫功能的影响.方法 前瞻性选取2021年1月至2022年12月就诊于重庆市开州区人民医院的晚期食管鳞状细胞癌患者130例作为研究对象.按照随机数字表法将患者分为对照组与观察组,每组各65例.对照组予以单纯化疗,观察组予以卡瑞利珠单抗联合化疗治疗.两组均以21 d为1个疗程,治疗4个疗程.观察两组的临床疗效,分别于治疗前和治疗4个疗程后,比较两组患者的生活质量(QoL)评分和Karnofsky功能状态(KPS)评分、血清肿瘤增殖相关因子(癌胚抗原、SCC、VEGF)和免疫功能(CD4+、CD8+、CD4+/CD8+比值),并统计两组不良反应发生情况.结果 观察组病灶缓解率为67.69％,显著高于对照组(49.23％),差异有统计学意义(P＜0.05).治疗4个疗程后,两组QoL评分和KPS评分均较治疗前升高,观察组的QoL评分和KPS评分分别为(47.52±5.31)、(83.84±5.25)分,均高于对照组[(43.11±5.49)、(79.37±5.42)分],差异均有统计学意义(P＜0.05).治疗4个疗程后,两组血清癌胚抗原、SCC、VEGF水平均较治疗前降低,且观察组的血清癌胚抗原、SCC、VEGF水平分别为(8.24±2.25)μg/L、(4.89±1.31)μg/L、(113.58±20.63)pg/mL,均低于对照组[(13.76±3.14)μg/L、(7.45±2.12)μg/L、(224.71±35.25)pg/mL],差异均有统计学意义(P＜0.05).治疗4个疗程后,两组CD4+、CD4+/CD8+均较治疗前降低,但观察组的CD4+、CD4+/CD8+分别为(30.29±2.94)％、1.06±0.17,均高于对照组[(28.51±2.78)％、0.98±0.15],差异均有统计学意义(P＜0.05);两组CD8+组内和组间比较,差异均无统计学意义(P＞0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 在化疗基础上联用卡瑞利珠单抗治疗晚期食管鳞状细胞癌患者可获得较好病灶缓解率,提升生活质量,能显著下调肿瘤增殖相关因子水平,改善免疫功能,且安全性较好.
Abstract
Objective To explore the efficacy of the combination of Karelizumab and chemotherapy in the treatment of esophageal squa-mous cell carcinoma and its effects on serum carcinoembryonic antigen,squamous cell carcinoma antigen(SCC),vascular endothelial growth fac-tor(VEGF)levels and immune function.Methods A total of 130 patients with advanced esophageal squamous cell carcinoma who visited Kaizhou District People's Hospital of Chongqing from January 2021 to December 2022 were prospectively selected as the study subjects.According to the random number table method,patients were divided into the control group and the observation group,with 65 cases in each group.The con-trol group was treated with simple chemotherapy,while the observation group was treated with a combination of Karelizumab and chemotherapy.Both groups were treated for one course of 21 days,with four courses of treatment.The clinical efficacy of two groups was observed,and the quality of life(QoL)score and Karnofsly's performance status(KPS)score,serum tumor proliferation related factors(carcinoembryonic antigen,SCC,VEGF),and immune function(CD4+,CD8+,CD4+/CD8+ratio)were compared between the two groups of patients before and after four cour-ses of treatment,and the occurrence of adverse reactions in the two groups was recorded.Results The remission rate of lesions in the observation group was 67.69％,which was significantly higher than that in the control group(49.23％),the difference was statistically significant(P＜0.05).After 4 courses of treatment,the QoL scores and KPS scores of two groups were higher than those before treatment,the QoL scores and KPS scores of the observation group were(47.52±5.31)and(83.84±5.25)points,respectively,which were higher than those of the control group[(43.11±5.49)and(79.37±5.42)points],and the differences were statistically significant(P＜0.05).After four courses of treat-ment,the levels of serum carcinoembryonic antigen,SCC,and VEGF were lower than those before treatment,the levels of serum carcinoembryonic antigen,SCC,and VEGF in the observation group were(8.24±2.25)μg/L,(4.89±1.31)μg/L,and(113.58±20.63)pg/mL,respec-tively,which were lower than those in the control group[(13.76±3.14)μg/L,(7.45±2.12)μg/L,and(224.71±35.25)pg/mL],and the differences were statistically significant(P＜0.05).After 4 courses of treatment,CD4+and CD4+/CD8+in two groups were lower than those before treatment,however,the CD4+and CD4+/CD8+in the observation group were(30.29±2.94)％and 1.06±0.17,respectively,which were higher than those in the control group[(28.51±2.78)％and 0.98±0.15],and the differences were statistically significant(P＜0.05).There was no statistically significant difference between the CD8+within and between the two groups(P＞0.05).There was no statisti-cally significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Karelizumab combined with chemotherapy has a significant effect on the treatment of advanced esophageal squamous cell carcinoma,which can improve lesion remission rate,enhance quality of life,reduce serum tumor proliferation related factor levels,improve immune function,and has good safety.
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