PD-1免疫抑制剂联合化疗治疗晚期NSCLC的效果及对肿瘤标志物、预后的影响

摘要 目的：探究PD-1免疫抑制剂联合化疗治疗晚期非小细胞肺癌（NSCLC）的效果及对肿瘤标志物、预后的影响。方法：回顾性选取2020.6~2023.6间收治的处于III B期~IV期NSCLC患者为研究对象，依据其治疗方案分为化疗组（n=32，培美曲塞/紫杉类+铂类化疗方案）和联合组（n=36，免疫抑制剂+培美曲塞/紫杉类+铂类化疗方案），治疗至少2个周期后比较两组实体瘤治疗效果[疾病控制率（DCR）、客观缓解率（ORR）]，随访预后生存情况[无进展生存期（PFS）、总生存期（OS）]，比较治疗期间药物不良反应，比较两组治疗前、治疗2个周期后的血清生化指标[癌胚抗原（CEA）、细胞角蛋白19片段抗原（CY-FRA21-1）和白蛋白（ALB）]水平变化。结果：治疗2个周期后，联合组DCR（83.33% vs 59.38%）显著高于化疗组（P<0.05），但ORR（58.33% vs 40.63%）与化疗组比较无显著差异（P>0.05）；随访18个月，联合组PFS为（11.44±1.81）个月，死亡11例，OS为（15.17±1.42）个月；化疗组PFS为（6.87±3.05）个月，死亡16例，OS为（11.91±1.09）个月，联合组PFS显著高于化疗组（log rank x²=4.377，P<0.05），两组OS比较无显著差异（log rank x²=3.442，P>0.05）；治疗期间，两组药物不良反应总发生率比较无显著差异（P>0.05）；治疗2个周期后，两组CEA和CY-FRA21-1水平逐渐降低（P<0.05），ALB水平显著升高（P<0.05），且联合组治疗2个周期指标变化显著高于化疗组（P<0.05）。结论：PD-1免疫抑制剂联合化疗治疗晚期NSCLC效果良好，可显著抑制肿瘤发展进程，延长患者PFS，改善预后，值得推荐。

Effect of PD-1 Immunosuppressant Combined with Chemotherapy in Treating Advanced NSCLC and Its Influence on Tumor Markers and Prognosis

ABSTRACT Objective: To explore the effect of PD-1 immunosuppressant combined with chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) and its influence on tumor markers and prognosis. Methods: Patients with stage III-B-IV NSCLC admitted from June 2020 to June 2023 were retrospectively selected as the study subjects, and were divided into chemotherapy group (n=32, pemetrexed/paclitaxel + platinum chemotherapy regimen) and combined group (n=36, camrelizumab + pemetrexed/ paclitaxel + platinum chemotherapy regimen). The solid tumor treatment effect [disease control rate (DCR), objective response rate (ORR)] and follow-up prognosis and survival [progression-free survival (PFS), overall survival (OS)] after at least 2 cycles of treatment, adverse drug reactions during treatment and levels of serum biochemical indicators [carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen (CY-FRA21-1), albumin (ALB)] before treatment and after 2 cycles of treatment were compared between both groups. Results: After 2 cycles of treatment, DCR in combined group was significantly higher than that in chemotherapy group (83.33% vs 59.38%) (P<0.05), but ORR was not significantly different from that in chemotherapy group (58.33% vs 40.63%) (P>0.05). After 18 months of follow-up, the PFS, the number of dead cases and OS in combined group were (11.44±1.81) months, 11 cases and (15.17±1.42) months and those in chemotherapy group were (6.87±3.05) months, 16 cases and (11.91±1.09) months. The PFS was significantly longer in combined group than that in chemotherapy group (log rank χ²=4.377, P<0.05), but there was no significant difference in OS between the two groups (log rank χ²=3.442, P>0.05). During treatment, the total incidence rate of adverse drug reactions showed no significant difference between the two groups (P>0.05). After 2 cycles of treatment, the levels of CEA and CY-FRA21-1 in both groups were gradually reduced (P<0.05) while the level of ALB was significantly risen (P<0.05), and the changes of the above indicators in combined group were significantly higher compared to chemotherapy group (P<0.05). Conclusion: PD-1 immunosuppressant combined with chemotherapy is effective in the treatment of advanced NSCLC, which can significantly inhibit the tumor progression, prolong the PFS, and improve the prognosis.