卡瑞利珠单抗联合化疗对中晚期食管癌的疗效、安全性分析及NLR对疗效的预测价值

Efficacy and safety of chemotherapy combined with camrelizumab in advanced esophageal cancer and the value of NLR in efficacy prediction

关键词:  食管癌  免疫治疗  卡瑞利珠单抗  不良反应  中性粒细胞-淋巴细胞比值

Key words:  esophageal cancer  immunotherapy  camrelizumab  adverse reactions  neutrophil lymphocyte ratio

摘要:

目的 探讨卡瑞利珠单抗联合化疗在中晚期食管鳞癌(esophageal squamous cell carcinoma, ESCC)治疗中的临床疗效及安全性，分析外周血中性粒细胞-淋巴细胞比值(neutrophil lymphocyte ratio, NLR)对卡瑞利珠单抗联合化疗在ESCC治疗效果的预测价值。 方法 回顾性分析在喀什地区第一人民医院接受卡瑞利珠单抗联合化疗（研究组92例）或单纯化疗（对照组76例）治疗的中晚期ESCC患者168例。分析两组客观缓解率(objective remission rate, ORR)、疾病控制率(disease control rate, DCR)、无进展生存期(progression free survival, PFS)、总生存期(overall survival, OS)和不良反应，采用Kaplan-Meier法进行生存分析。分析NLR对卡瑞利珠单抗联合化疗治疗ESCC的疗效预测价值。 结果 研究组完全缓解（complete response, CR）、部分缓解（partial response, PR）、疾病稳定（stable disease, SD）、ORR、DCR、新辅助化疗后手术等指标均高于对照组，差异有统计学意义(P＜0.05)。研究组及对照组的中位PFS（8.7个月 vs 4.6个月）及中位OS（14.8个月 vs 11.2个月）较对照组明显提高（P＜0.001)。研究组部分不良反应与对照组相比发生率较高（P＜0.05），但在可以控制的范围内，安全性尚可。高NLR2组患者PFS率及OS率比低NLR2组患者低（P<0.001），ROC曲线NLR2曲线下面积为0.91（P＜0.001），NLR2≥3.12是ESCC患者预期PFS及OS生存获益的危险因素(P＜0.001）。 结论 卡瑞利珠单抗联合化疗相比单纯化疗延长中晚期ESCC患者的PFS及OS，提高ORR、DCR，安全性良好。NLR2对卡瑞利珠单抗联合化疗治疗效果有良好的预测价值。

Abstract:

Objective To investigate the clinical efficacy and safety of chemotherapy combined with camrelizumab in the treatment of advanced esophageal squamous cell carcinoma(ESCC), and to analyze the predictive value of peripheral blood neutrophil lymphocyte ratio(NLR) for the therapeutic effect. Methods Clinical data of 168 patients with advanced ESCC admitted in the First People’s Hospital in Kashgar region from January 2018 to April 2022 were retrospectively analyzed, including 92 cases received a combination of chemotherapy and camrelizumab(study group) and 76 case received chemotherapy alone(control group). The objective response rate(ORR), disease control rate(DCR), progression free survival(PFS), overall survival(OS), and adverse reactions of two groups were compared between two groups, and Kaplan Meier method was used for survival analysis. The value of NLR for prediction of the therapeutic efficacy was evaluated with ROC curve. Results The indicators of CR, PR, SD, ORR and DCR in the study group were significantly higher than those in the control group(P<0.05). The median PFS(8.7 months vs 4.6 months) and median OS(14.8 months vs 11.2 months) of the study group were significantly higher than those of the control group(P<0.001). The incidence of adverse reactions in the study group was higher than that in the control group(P<0.05), but within a controllable range and the safety was still acceptable. The PFS and OS rates of patients in the high NLR2 group were lower than those in the low NLR2 group(P<0.001), and the area under the ROC curve(AUC) of NLR2 for prediction of therapeutic efficacy was 0.91(P<0.001). NLR2≥3.12 is a risk factor for the poorer PFS and OS of ESCC patients(P<0.001). Conclusion Camrelizumab combined with chemotherapy prolongs PFS and OS, and improves ORR and DCR in patients with advanced ESCC compared to chemotherapy alone, and NLR2 has a good predictive value for the efficacy of treatment.