新辅助化疗联合免疫治疗对食管癌根治术患者围术期肾功能的影响
Effect of neoadjuvant chemotherapy combined with immunotherapy on perioperative renal function in patients undergoing radical resection for esophageal cancer
王凯元 1涂慧芳 2邓城旗 1关山 1耳建旭 3尹毅青1
作者信息
- 1. 天津医科大学肿瘤医院麻醉科 国家恶性肿瘤临床医学研究中心 天津市恶性肿瘤临床医学研究中心 天津市肿瘤防治重点实验室,天津 300060
- 2. 天津中医药大学研究生院,天津 301617
- 3. 天津大学胸科医院麻醉科,天津 300222
- 折叠
摘要
目的 评价新辅助化疗联合免疫治疗对食管癌根治术患者围术期肾功能的影响.方法 本研究为回顾性队列研究.收集2020年1月至2022年4月于天津医科大学肿瘤医院和天津大学胸科医院行食管癌根治术患者的临床资料,根据患者术前治疗方案分为2组:新辅助化疗组(nCT组)和新辅助化学联合免疫治疗组(nCT+IT组).nCT组接受以铂类药为基础,结合氟尿嘧啶或紫杉醇的新辅助化疗;nCT+IT组在接受新辅助化疗的基础上,联合使用程序性死亡受体1抗体药物进行免疫治疗.患者均接受了 2～3个周期的治疗,每个周期21 d,在治疗完成后4～6周进行手术.收集治疗前、术前72 h及术后72 h的血清肌酐、尿酸及尿素浓度.采用KDIGO标准诊断急性肾损伤(AKI),记录术前72 h及术后72 h时AKI发生情况.收集患者术后病理完全缓解率、复发率和无病生存时间.结果 与nCT组比较,nCT+IT组治疗后血清尿素浓度升高,术前72 h和术后72 h时血清尿酸浓度升高,术后病理完全缓解率升高,复发率降低,无病生存时间延长(P＜0.05),术前72 h和术后72 h时AKI发生率差异无统计学意义(P＞0.05).结论 新辅助化疗联合免疫治疗虽然可提高食管癌根治术患者病理完全缓解率和无病生存率,但对肾功能会产生一定的影响,围术期应加强肾功能检测,防止 AKI的发生.
Abstract
Objective To evaluate the effect of neoadjuvant chemotherapy combined with immuno-therapy on the perioperative renal function in patients undergoing radical resection for esophageal cancer.Methods This was a retrospective cohort study.Clinical data from patients undergoing neoadjuvant chemo-therapy combined with immunotherapy for esophageal cancer in Tianjin Medical University Cancer Institute& Hospital and Tianjin University Chest Hospital from January 2020 to April 2022 were retrospectively col-lected.According to the preoperative treatment regimen,the patients were divided into neoadjuvant chemo-therapy group(group nCT)and neoadjuvant chemotherapy combined with immunotherapy group(group nCT+IT).nCT group underwent neoadjuvant chemotherapy,which included a platinum-based regimen com-bined with fluorouracil or taxanes.In nCIT+IT group,programmed cell death protein 1 inhibitors were used for immunotherapy based on neoadjuvant chemotherapy.All the patients underwent 2-3 cycles of therapy,with each cycle lasting 21 days.Surgery was performed 4-6 weeks after the completion of the last therapy.The concentrations of serum creatinine,uric acid and blood urea nitrogen were detected before therapy,at 72 h before surgery and at 72 h after surgery.The acute kidney injury(AKI)diagnosed by the Kidney Dis-ease:Improving Global Outcomes criteria at 72 h before surgery and 72 h after surgery were recorded.The pathological complete response rates,recurrence rate and disease-free survival time after surgery were col-lected.Results Compared with group nCT,the serum urea concentration was significantly increased after treatment,the serum uric acid concentrations were increased at 72 h before surgery and 72 h after surgery,the pathological complete response rate was increased,the recurrence rate was decreased,the disease-free survival time was prolonged(P＜0.05),and no statistically significant changes were found in the incidence of AKI at 72 h before surgery and 72 h after surgery in group nCT+IT(P＞0.05).Conclusions Although neoadjuvant chemotherapy combined with immunotherapy can raise the pathological complete response rate and disease-free survival rate,it has a certain effect on renal function.Perioperative renal function testing should be strengthened to prevent the occurrence of AKI in the patients undergoing radical resection for esophageal cancer.
关键词
新辅助化疗/免疫疗法/食管肿瘤/肾功能试验Key words
Neoadjuvant chemotherapy/Immunotherapy/Esophageal neoplasms/Kidney function tests引用本文复制引用
基金项目
天津麻醉科研发展计划(TJMZ2021-M001)
天津市"项目+团队"重点培养专项(创新类)(XC202034)
天津市医学重点学科(专科)建设项目(TJYXZDXK-010A)
出版年
2024
NETL
NSTL
万方数据