杜鸣宇,尹 丽,解 鹏,等.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[J].肿瘤学杂志,2022,28(11):908-915.
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
Efficacy and Safety of Radiotherapy Combined with Immunotherapy in Patients with Advanced or Metastatic Esophageal Squamous Cell Carcinoma
投稿时间:2022-08-20  
DOI:10.11735/j.issn.1671-170X.2022.11.B004
中文关键词:  食管鳞癌  放射治疗  PD-1  免疫治疗
英文关键词:esophageal squamous cell carcinoma  radiotherapy  PD-1  immunotherapy
基金项目:希思科-豪森肿瘤研究基金重点课题项目(Y-HS202102-0177)
作者单位
杜鸣宇 江苏省肿瘤医院 江苏省肿瘤防治研究所南京医科大学附属肿瘤医院 
尹 丽 江苏省肿瘤医院 江苏省肿瘤防治研究所南京医科大学附属肿瘤医院 
解 鹏 江苏省肿瘤医院 江苏省肿瘤防治研究所南京医科大学附属肿瘤医院 
邢 鹏 泾县医院 
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中文摘要:
      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。
英文摘要:
      Abstract:[Objective] To evaluate the efficiency and safety of radiotherapy combined with immunotherapy in patients with advanced or metastatic esophageal squamous cell carcinoma(ESCC). [Methods] Clinical data of 118 patients with advanced or metastatic ESCC who received radiotherapy combined with sequential immunotherapy or concurrent immunotherapy in Jiangsu Cancer Hospital from June 2017 to June 2020 were retrospectively analyzed. The efficacy and adverse effects were compared between patients receiving sequential immunotherapy and concurrent immunotherapy. Chi square test was used to analyze the difference between the two groups, and Log-rank method was used to compare the survival curve. [Results] The median follow-up time was 9 months. The median progression free survival(PFS) was 6 months(1~39 months) and the median overall survival(OS) was 7 months(1~43 months). The 1-year PFS rate and OS rate were 26.8%, 27.4% and 51.6%, 48.3% respectively in sequential and concurrent immunization groups. Subgroup analysis showed that in the sequential group, the median OS of immunotherapy for the second line and the third line was 17 months and 10 months,respectively, the corresponding 1-year OS rate was 56.9% and 44.4%, respectively(P=0.039), and the 1-year PFS was 19.3% and 14.7%, respectively(P=0.049). In patients with immunotherapy as second line therapy,the 1-year OS rate in sequential and concurrent groups was 56.9% and 56.0% respectively(P=0.556), in patients with immunotherapy as third line therapy the 1-year OS rate of the two groups was 43.5% and 33.3%, respectively(P=0.744). In terms of side effects, 5 cases(4.1%) had >3 degrees of toxicity, while 43 cases(35.5%) had 1~2 degrees of toxicity, including 29 cases(24.6%) of pneumonia. [Conclusion] The combination of radiotherapy and immunotherapy has a certain effect in patients with advanced or metastatic ESCC. While immunotherapy in the first and second lines can bring more survival benefits. However, there is no significant difference in adverse effects and survival of patients between using immunotherapy sequentially or concurrently.
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