晚期或转移性食管鳞癌免疫治疗联合放疗的疗效及安全性研究

摘 要：［目的］ 评估在晚期胸段食管鳞癌患者中放疗序贯免疫治疗和放疗同步免疫治疗的疗效及副反应。［方法］ 回顾性分析2017年6月至2020年6月在南京医科大学附属肿瘤医院同时接受免疫治疗和放疗的晚期胸段食管鳞癌病例118例,根据联合治疗的时机及顺序将患者分为两组,序贯组为先放疗后序贯免疫治疗,同步组为放疗同步免疫治疗。分析比较两组患者的疗效及副反应差异。采用Log-rank法比较生存曲线。［结果］ 中位随访时间9个月,中位无进展生存期（progression free survival,PFS）为6个月（1~39个月）,中位总生存期（overall survival,OS）为 7个月（1~43个月）。放疗序贯免疫治疗和同步免疫治疗两组的1年PFS 及OS分别为26.8%、27.4%和51.6%、48.3%。亚组分析显示：放疗序贯免疫治疗组,二线使用对比三线使用的中位OS分别为17个月、10个月（1年OS分别为56.9%、44.4%,P=0.039;1年PFS为19.3%、14.7%,P=0.049)。但是,在二线治疗中,放疗序贯免疫治疗组、放疗同步免疫治疗组两组1年OS 分别为56.9%、56.0%(P=0.556);在三线治疗中,两组1年OS分别为43.5%、33.3%（P=0.744）。出现3级以上副反应5例（4.1%）,1~2级副反应43例（35.5%）,主要是肺炎29例（24.6%）。［结论］ 免疫治疗联合放疗对于晚期胸段食管鳞癌患者疗效肯定;治疗时机放在一线、二线使用能带来更多生存获益;在治疗顺序上,二线或三线使用序贯或同步治疗无统计学意义生存差异;两组副反应差异无统计学意义。     

晚期食管鳞癌免疫治疗的现状与未来方向

食管鳞状细胞癌（esophageal squamous cell carcinoma,ESCC）是消化道最具侵袭性的恶性肿瘤之一。我国ESCC的发病率和死亡率均处于全球前列,总体生存率低。因此,迫切需要新的治疗手段改善ESCC尤其是确诊为晚期患者的预后。近年来以免疫检查点抑制剂（immune checkpoint inhibitors,ICIs）为代表的免疫治疗在ESCC全身治疗领域取得了明显进展,随着临床试验不断推进,免疫治疗显现出巨大的应用前景。全文就晚期ESCC免疫治疗的现状及未来的方向作一综述。     

晚期肺鳞癌靶向及免疫治疗进展

肺癌是目前世界上发病率和死亡率最高的恶性肿瘤。其中,肺鳞癌（squamous-cell lung cancer,SQCLC）为一种常见的病理类型。近年来,许多学者针对肺鳞癌的靶向药物与免疫制剂进行大量的科学研究及临床试验,EGFR单克隆抗体、VEGFR的单克隆抗体、免疫检查点抑制剂等多种药物已在临床试验中取得了一定成果。本文对晚期肺鳞癌的分子靶向治疗及免疫治疗进行系统性的阐述,通过分析其在提高患者生存率、改善生存质量等方面取得的实质性研究成果,探讨目前临床上晚期肺鳞癌的靶向及免疫治疗进展及未来发展方向。     

阿帕替尼后线治疗晚期食管鳞癌患者的疗效及安全性

目的 探讨阿帕替尼后线治疗晚期ESCC患者的疗效和安全性.方法 纳入56例后线接受阿帕替尼单药治疗的晚期ESCC患者.阿帕替尼治疗的起始剂量为每天500 mg或250 mg.分析患者的临床病理资料、不良反应及预后.研究主要终点为无进展生存期(PFS),次要终点为客观缓解率(ORR)、疾病控制率(DCR)、总生存期(OS...     

局部晚期可手术食管鳞癌的治疗策略

局部晚期可手术食管鳞癌的治疗日趋综合化、个体化,围绕手术这个基石,有诸多组合模式,如术后化疗、术后放疗、术后放化疗、围手术期化疗、新辅助化疗、新辅助放疗及新辅助放化疗等,也包括非手术治疗的根治性同步放化疗、放疗联合免疫治疗等模式,更有新的治疗模式的探讨。其中,新辅助放化疗越来越得到业内人士的广泛认可。本文对上述治疗模式加以简要综述,以期规范食管癌的治疗。     

局部晚期食管鳞癌术前同期放化疗疗效及预后因素分析

目的评价局部晚期食管鳞癌术前同期放化疗治疗效果和影响预后的因素。方法回顾分析2007-2017年郑州大学附属肿瘤医院收治的148例经术前同期放化疗并手术治疗的局部晚期食管鳞癌患者资料,化疗采用氟尿嘧啶+顺铂或紫杉醇+顺铂方案,放疗剂量为36~40Gy,常规分割。Kaplan-Meier法计算生存率并Logrank检验及单因素分析,Cox模型多因素分析。结果全组1、3、5年总生存率分别为74%、51%、51%,无瘤生存率分别为60%、51%、45%;中位生存期为72.4个月,无瘤生存期为60.1个月。pCR与非pCR的1、3、5年总生存率分别为86%、70%、70%与70%、44%、43%(P=0.002),无瘤生存率分别为76%、71%、68%与53%、43%、37%(P=0.002)。pN(-)与pN(+)的1、3、5年总生存率分别为83%、56%、55%与50%、38%、38%(P=0.004),无瘤生存率分别为66%、56%、51%与43%、38%、31%(P=0.006)。多因素分析显示是否pCR和pN状态是影响总生存和无瘤生存的因素(P=0.012、0.011和P=0.025、0.033)。结论术前同期放化疗治疗局部晚期食管鳞癌疗效显著,是否pCR和pN状态是预后影响因素。     

晚期胃 食管胃结合部腺癌免疫治疗临床分析

  目的  探讨晚期胃/食管胃结合部（gastric/gastroesophageal junction,G/GEJ）腺癌中程序性细胞死亡受体（programmed cell death protein 1, PD-1）单抗临床疗效分析。  方法  收集2018年9月至2020年9月就诊于河南省肿瘤医院接受PD-1单抗治疗晚期胃/食管胃结合部腺癌患者的临床数据资料。  结果  收集123例（5例失访）患者,中位随访时间12.6个月。118例患者客观缓解率（overall response rate, ORR)为22.0%,疾病控制率（disease control rate, DCR)为51.7%,中位无进展生存期（progression-free survival, PFS)为5.0个月,中位总生存期(overall survival, OS)为8.9个月。一线 vs. 二线 vs. 三线及以上ORR为（37.0% vs. 20.5% vs. 14.9%,P=0.002）,DCR为（81.5% vs. 54.5% vs. 29.8%,P<0.001）,中位PFS为（9.9个月 vs. 4.8个月 vs. 3.2个月）,中位OS为（19.0 个月vs. 7.8个月 vs. 7.3个月）。PD-1单抗联合化疗 vs. 抗血管 vs. 化疗及抗血管治疗中位PFS为（5.8个月 vs. 4.4个月 vs. 5.0个月）及中位OS为（11.4个月 vs. 8.2个月 vs. 8.2个月）。免疫联合化疗一线（22例）vs.二线（20例）中位PFS为（9.0个月 vs. 4.7个月,P=0.003）,中位OS为（NR vs. 7.8个月,P=0.007）。程序性死亡配体(programmed cell death-ligand 1, PD-L1)表达（CPS≥1% vs. CPS<1%）中ORR为(37.1% vs. 13.3%),DCR为(65.7% vs. 46.7%),中位PFS为（5.8个月 vs. 4.7个月）,中位OS为(11.3个月 vs. 9.3个月)。多因素分析显示年龄、ECOG评分、转移灶数目、腹膜转移及免疫治疗线数是患者OS独立影响因素（P<0.05）,且年龄为保护性因素（HR=0.498,95%CI:0.255～0.974）。  结论  晚期胃/食管胃结合部腺癌早期采用PD-1单抗联合治疗可有效延长患者PFS及OS。PD-1单抗联合化疗及抗血管治疗均有一定优势,但具体时机尚需进一步探索研究。      

手术治疗原发性食管腺癌的预后分析及与同期食管鳞癌对比

目的 :了解原发性食管腺癌的手术治疗情况及影响患者预后的重要因素,探讨其与同期手术治疗的食管鳞癌的类同和差异。 方法 :对42例食管腺癌患者的外科治疗结果进行回顾性研究,并与同期1938例外科治疗的食管鳞癌进行对比分析;利用SPSS软件对可能影响原发食管腺癌及鳞癌预后的多个因素进行分析,找出影响预后的因素。 结果 :食管腺癌患者的男女比为4.3:1,发病中位年龄61岁,平均病程4个月,肿瘤平均长度5cm;手术切除率及手术并发症发生率分别为88.1%和7.1%,术后1、3、5年生存率分别为69.0%、35.7%、16.7%。 结论 :原发性食管腺癌与食管鳞癌在一般临床特征上相似,腺癌淋巴结转移率高。食管腺癌患者预后取决于肿瘤病理分期、侵犯深度及有无淋巴结转移,早期发现、早期诊断、早期规范根治性手术及综合治疗是改善预后的主要手段。     

食管鳞癌患者预后因素分析

目的 近年来食管鳞癌的预后虽然有所改善,但其结果仍不能令人满意.本研究回顾性分析手术根治切除的食管鳞癌患者的临床病理资料,以探讨影响患者术后生存的主要因素.方法 收集2009-01-01-2013-12-31在河南省肿瘤医院行食管癌根治术的2558例患者临床资料,应用寿命表法计算患者术后总的1、3和5年生存率,用Kaplan-Meier法计算患者累积生存率,并绘出生存曲线,组间比较用Log-Rank检验,多因素分析采用Cox模型分析.结果 全组患者总的1、3和5年生存率分别为87％、63％和46％.单因素分析结果显示,年龄(x2=16.28,P＜0.05)、肿瘤部位(x2 =7.02,P＜0.05)、肿瘤长度(x2=56.24,P＜0.001)、病理形态(x2=27.62,P＜0.001)、分化程度(x2 =8.88,P＜0.05)、浸润程度(x2=104.03,P＜0.001)、切缘肿瘤细胞残留(x2=6.45,P＜0.05)、有无淋巴结转移(x2=102.57,P＜0.001)和TNM分期(x2=170.84,P＜0.001)为食管鳞癌患者术后生存时间的影响因素.多因素Cox分析显示,有无淋巴结转移(x2 =7.62,P＜0.05)、TNM分期(x2=4.93,P＜0.05)、浸润程度(x2 =6.33,P＜0.05)、年龄(x2=9.89,P＜0.05)和分化程度(x2 =4.38,P＜0.05)为食管鳞癌患者预后的独立危险因素.结论 影响食管鳞癌患者术后生存的因素有多种,因此临床医师应结合患者的具体情况,选择最恰当的治疗措施和方案,以提高患者生存质量,延长生存期,改善患者的预后.     

老年食管鳞癌根治性放化疗疗效观察及预后分析

背景与目的：随着人口的老龄化,≥70岁老年食管癌患者越来越多,然而对这部分患者的研究资料并不多,本研究评价老年食管鳞癌患者根治性放化疗疗效及相关预后因素。方法：回顾性分析2009年3月—2011年12月在复旦大学附属肿瘤医院放疗科接受根治性放化疗的年龄≥70岁的食管鳞癌初治患者治疗疗效及相关预后因素。结果：共53例符合条件的患者,中位年龄74岁;单纯放疗患者29例,同期放化疗患者24例;1、2、3和5年生存率分别为62%、44%、33%和19%;2度及以上急性放射性食管炎及放射性肺炎发生率分别为6%和9%,无一例患者发生4度及以上放射性损伤。COX多因素分析显示,治疗方式、病变部位以及吸烟史与患者的预后明显相关。结论：放疗能为老年食管鳞癌患者所耐受,是一种安全的治疗方式,同期化疗的参与能够提高患者治疗的疗效。     

Pembrolizumab combined with paclitaxel and platinum as induction therapy for locally advanced esophageal squamous cell carcinoma: a retrospective,single-center,three-arm study

BackgroundPembrolizumab has been shown to have a powerful benefit for locally advanced or metastatic esophageal cancer. The aim of present study was to evaluate the efficacy and safety of pembrolizumab combined with neoadjuvant chemotherapy for locally advanced and potentially resectable esophageal squamous cell carcinoma (ESCC).MethodsPatients diagnosed with clinical stage III-IV ESCC and have a chance of resectability at Fujian Provincial Hospital were included into this study. Patients received pembrolizumab in combination with paclitaxel and nedaplatin as induction therapy once every 3 weeks in the first stage. After 4 cycles of pembrolizumab therapy, the patients then chose to undergo radical surgery (group A), radical radiotherapy (group B), or neither (group C). In the third stage, maintenance treatment with pembrolizumab was administered to all patients.ResultsA total of 39 patients (33 male and 6 female) with a median age of 64 years were included. After immune response evaluation in the first stage, 34 (87.2%) patients achieved immune partial response (iPR), and 5 (12.8%) patients achieved immune stable disease (iSD). The objective response rate (ORR) was 87.2% (34/39), and the disease control rate (DCR) was 100%. In the second stage, 22 patients received radical surgery, all of whom achieved R0 resection. The major pathological response (MPR) rate was 68.2% (15/22), and the pathological complete response (pCR) rate was 45.5% (10/22). Of the patients, 9 chose radiotherapy as the radical therapeutic method and 8 chose not to undergo any radical therapy. The median period of pembrolizumab therapy was 8 cycles (4–22 cycles). The median follow-up time was 14 months (3–34 months). The median overall survival and progression-free survival (PFS) times were not reached. The incidence of severe adverse events (AEs) (grade ≥3) was 15.4% (6/39).ConclusionsPembrolizumab combined with paclitaxel and platinum for locally advanced and potentially resectable ESCC has a high ORR, high surgical conversion, MPR, pCR, and R0 resection rates, and tolerable AEs. Also, pembrolizumab could provide good benefits in sequential treatment with radical radiotherapy or maintenance therapy.     

The safety and efficacy of neoadjuvant PD-1 inhibitor with chemotherapy for locally advanced esophageal squamous cell carcinoma

BackgroundNeoadjuvant therapy followed by esophagectomy has been recognized as an effective treatment for locally advanced esophageal cancer, though still has a dismal prognosis. Antibodies against programmed death 1 (PD-1) protein improve survival in patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) compared with chemotherapy in second-line therapy. However, neoadjuvant PD-1 inhibitor combined with chemotherapy has not been tested in locally advanced ESCC. We conducted this study to evaluate the efficacy and safety of pd-1 inhibitor in neoadjuvant chemotherapy.MethodsIn this study, we administered 28 adults with untreated, surgically resectable locally advanced ESCC. PD-1 inhibitor with chemotherapy [albumin paclitaxel 100 mg/m² on days 1 and 8 + carboplatin with an area under the curve (AUC) of 5 on day 1] were administered every 3 weeks intravenously, and surgery was performed approximately 3–5 weeks after the second dose. The primary purpose of the study was to evaluate the feasibility and safety of this regimen.ResultsIn all, 28 locally advanced ESCC patients were enrolled, 27 patients received surgery, 9 (33.3%) patients’ postoperative pathological specimens suggested pCR, and 11 (40.7%) patients’ primary tumor suggested complete response. Neoadjuvant PD-1 inhibitor with chemotherapy had an acceptable side-effect profile, 26 patients’ tumors were completely resected (96.3% were R0). According to the RESIST v.1.1, the response in all 27 patients was evaluated by a computed tomography (CT) scan before surgery, showing 12 patients with complete response (CR), 12 with partial response (PR), and 3 with stable disease (SD). For surgical procedures, 15 (55.6%) patients underwent minimal invasive surgery, 4 (14.8%) underwent right transthoracic open esophagectomy, and 8 (29.6%) underwent hybrid approaches.ConclusionsThe novel treatment of PD-1 inhibitor with chemotherapy in the neoadjuvant setting for locally advanced ESCC produced satisfactory outcomes: an unprecedentedly high pCR rate for neoadjuvant chemotherapy, a high R0 resection rate, and a low-toxicity profile were achieved. The long-term efficiency of this novel treatment and the validity of the present findings should be confirmed with longer follow-up and prospective comparative trials.     

晚期食管鳞状细胞癌一线多种PD-1抑制剂免疫治疗策略的成本-效用分析

目的：评估多种PD-1抑制剂联合化疗用于晚期、复发或转移性食管鳞状细胞癌（ESCC）患者一线治疗的成本效用。方法：基于4项晚期ESCC一线Ⅲ期临床试验（JUPITER-06、ESCORT-1st、ORIENT-15和KEYNOTE-590研究）,应用TreeagePro 2011软件建立传统的马尔科夫（Markov）模型,包括无进展生存期（PFS）、疾病进展（PD）和死亡3种状态,以质量调整生命年（QALY）为主要效用指标衡量健康结果,以增量成本-效用比（ICER）为治疗策略经济学效益的评价指标,进一步通过敏感性分析验证结果可靠性。结果：特瑞普利单抗联合化疗组、卡瑞利珠单抗联合化疗组、信迪利单抗联合化疗组、帕博利珠单抗联合化疗组和安慰剂联合化疗组的总成本分别为66 327.58、63 473.64、62 268.18、295 515.26和32 753.79元,效用值分别为0.648、0.605、0.673、0.585和0.536 QALY;其中,信迪利单抗联合化疗组的ICER值为217 018.13元/QALY,低于中国患者意愿支付阈值的242 928元/QALY,是一种相对可接受的...     

Cost-effectiveness of camrelizumab versus chemotherapy for the treatment of advanced or metastatic esophageal squamous cell carcinoma

BackgroundTo evaluate the cost-effectiveness of camrelizumab versus chemotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) from the perspective of health system and to provide a basis for health decisions in China.MethodsA Markov model of 3 health states throughout the lifetime was established based on data from the ESCORT trial. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. The time horizon of lifetime was 5 years and each model cycle represented 2 months. The cost and utility value adopted a 5% discount rate per year. One-way sensitivity analysis and probability sensitivity analysis were used to test the robustness of the results.ResultsThe results of the cost-effectiveness analysis revealed that the camrelizumab group produced a gain of 2.93 QALY, at a cost of $37,809.12 USD, and the chemotherapy group gained 2.85 QALY, at a cost of $3,7071.52 USD. Camrelizumab was more cost-effective than chemotherapy for patients with advanced or metastatic ESCC. The results of one-way sensitivity analyses showed that the cost of camrelizumab, cost of chemotherapy and utility of progression-free survival (PFS) state were the top three parameters influencing the model. The probability sensitivity analysis results showed that the results of the basic case analysis were stable.ConclusionsUnder the willingness to pay threshold of three times per capita GDP of China, camrelizumab as second-line treatment could provide more health benefits for advanced or metastatic ESCC in China.     

B细胞易位基因2在食管鳞癌组织中的表达及临床意义

目的:探讨B细胞易位基因2（BTG2）在食管鳞状细胞癌（ESCC）组织中的表达及临床意义。方法:分析癌症基因组图谱（TCGA）数据库中BTG2 mRNA在ESCC组织及癌旁组织中的表达,受试者工作特征（ROC）曲线分析BTG2 mRNA表达量在预测ESCC患者疾病状态和放疗敏感性中的诊断价值;免疫组织化学检测我院184例ESCC患者癌组织标本BTG2蛋白表达,其中包括55例行根治性放疗术的ESCC患者,50例正常黏膜组织作为对照。分析BTG2蛋白表达情况与ESCC临床特征的关系。结果:与对照组比较,BTG2 mRNA在ESCC组织中表达下降（5.08±1.06 vs 5.91±1.29,t=2.387,P=0.019）,与放疗敏感组患者比较,BTG2 mRNA在放疗抵抗的ESCC患者癌组织中表达下降（3.82±0.97 vs 5.44±0.73,t=4.935,P＜0.001）,ROC结果显示BTG2 mRNA在鉴别放疗敏感与放疗抵抗患者时特异性为95.65%,敏感性为75%（AUC=0.902,P＜0.001）;免疫组织化学结果显示ESCC组织中BTG2阳性表达（103/184）低于正常黏膜组织（42/50）,差异有统计学意义（χ2=13.10,P＜0.001）;BTG2表达在放疗敏感和放疗抵抗组织中的阳性表达率分别为57.9%（22/38）和23.5%（4/17）,差异有统计学意义（χ2=5.565,P=0.018）;ESCC患者BTG2蛋白表达差异在不同性别、年龄、T分期及M分期中无统计学差异（P＞0.05）,与N分期（χ2=4.134,P=0.042）及临床分期（χ2=5.303,P=0.021）相关;单因素分析结果显示,肿瘤分级（HR=0.500,95%CI:0.317～0.790,P=0.003）、N分期（HR=0.275,95%CI:0.157～0.479,P=0.000）、M分期（HR=0.317,95%CI:0.151～0.665,P=0.002）、临床分期（HR=0.269,95%CI:0.167～0.434,P=0.000）及BTG2表达（HR=1.956,95%CI:1.242～3.079,P=0.003）与ESCC患者总生存（OS）有关;多因素分析结果显示,肿瘤分级（HR=0.613,95%CI:0.381～0.987,P=0.044）、N分期（HR=0.507,95%CI:0.259～0.991,P=0.047）、临床分期（HR=0.504,95%CI:0.278～0.916,P=0.025）及BTG2表达（HR=1.608,95%CI:1.011～2.558,P=0.045）影响ESCC患者的OS。结论:BTG2具有作为预测ESCC进展及放疗敏感性生物标记物的潜在价值,并且是影响ESCC患者总生存率的独立预后因素。     

食管癌放化疗中循环肿瘤细胞的变化及其临床意义

目的：探讨局部晚期食管癌放化疗中循环肿瘤细胞（circulating tumor cells ,CTCs）的动态变化,以及CTCs与食管癌临床特征和预后的相关性分析。方法：利用免疫磁珠富集联合免疫荧光检测2011年5 月至2013年5 月江苏大学附属人民医院48例局部晚期食管癌患者放化疗前后的循环血肿瘤细胞,对比分析放化疗前后的动态变化,并分析循环肿瘤细胞与患者临床特征及2 年生存率的关系。结果：循环血肿瘤细胞与肿瘤侵犯程度、淋巴结转移状态及临床分期均显著相关（P < 0.05）,治疗前循环血肿瘤细胞阳性率为52.1%（25/ 48）,治疗结束后为20.8%（10/ 48）,差异具有统计学意义（P < 0.01）。 放化疗前后的循环肿瘤细胞均与患者的2年生存率密切相关（P < 0.05）,Cox 回归分析提示临床分期及放化疗后循环血肿瘤细胞水平是食管癌患者的独立预后因子。结论：循环肿瘤细胞可以反映局部晚期食管癌患者的疾病进展程度,并且可以作为判断预后的指标。     

Genomic characteristics in neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

BackgroundThe response to neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal squamous cell carcinoma (ESCC) can vary, but there is still no biomarker that can identify the benefiting population. Therefore, biomarkers to predict the outcome of nCRT are needed, as well as elucidation of the mechanism of resistance therapy. We investigated differences of genomic characteristics between patients with a pathologic complete response (pCR) and those with little or no response (pathologic stable disease: pSD) before and after nCRT.MethodsFourteen subjects with locally advanced ESCC (7 cases of pCR and 7 of pSD) who received nCRT before undergoing esophagectomy were enrolled. An analysis of whole-exome sequencing (WES) data from 27 ESCC tissue samples obtained from the subjects pre and post nCRT was performed.ResultsThe number of pretherapy samples displaying loss of chromosome 19p13.11 was higher in the pCR group than in the pSD group (5/6) (P=0.0291, Fisher’s exact test). Gain of 19q13.31 was observed significantly more often in the samples obtained following nCRT (5/14). KMT2A missense mutation was found more frequently in the pSD group’s pre-nCRT samples than in those of the pCR group (3/6), and following nCRT, new genes such as NF1, KMT2D, NOTCH2, and NIPBL were detected new variations. C/G>G/C (P=0.003) and C/G>A/T (P=0.002) transitions were statistically significantly reduced in every patient after nCRT, with similar observations made in both groups (pCR group: C/G>G/C, P=0.027; C/G>A/T, P=0.004; and pSD group: C/G>G/C, P=0.032; C/G>A/T, P=0.017).ConclusionsBiomarkers to predict pCR might include 19p13.11 copy number loss and KMT2A missense mutation. Further validation in a prospective study of a larger sample is required.     

营养免疫炎性指标预测免疫联合放化疗二线治疗食管鳞癌患者预后的价值

  目的  评估营养免疫炎性指标用于预测接受camrelizumab联合放（化）疗二线治疗复发和（或）转移转移食管鳞癌（relapsed or metastatic esophageal squamous cell carcinoma ,R/M ESCC）患者预后的价值。  方法  从2018年1月至2021年3月,从河北医科大学第四医院筛选出48例符合入组标准的R/M ESCC患者进行回顾性分析,根据受试者工作特征曲线（receiver operating characteristic curve,ROC）确定预后营养指数（prognostic nutritional index, PNI）、中性粒细胞淋巴细胞比（neutrophilic-to-lymphocyte ratio,NLR）、血小板与淋巴细胞比（platelet-to-lymphocyte ratio,PLR）和全身免疫-炎症指数（systemic immune-inflammation index,SII）这4项指标预测患者预后的最佳临界值。应用SPSS 25.0版本软件进行单因素和多因素统计学分析。  结果  全组患者二线免疫治疗后的1、2年生存（overall survival,OS）率和无进展生存（progression-free survival,PFS）率分别为42.9%、22.5%和29.0%、5.8%;中位OS和PFS分别为9.0个月（95%CI：6.4～11.7）和8.5个月（95%CI：1.5～5.6）。多因素分析结果显示免疫联合方式、近期疗效、PNI、NLR、PLR和SII为患者OS的独立影响因素（P=0.044、0.030、<0.001、0.040、0.044、0.036）;免疫联合方式、使用免疫周期数、近期疗效、PNI、NLR、PLR和SII为患者PFS的独立影响因素（P=0.049、0.024、0.003、0.017、0.008、<0.001、0.009）。  结论  低PNL,高NLR、PLR和SII值为接受camrelizumab联合放（化）疗二线治疗R/M ESCC预后较差的独立性预测指标。