| 曹旭欢,雒小佳,孙玄子,等.食管癌肿瘤微环境免疫细胞浸润对顺铂联合氟尿嘧啶同步放化疗的疗效及预后价值[J].肿瘤学杂志,2026,32(9):774-780. |
| 食管癌肿瘤微环境免疫细胞浸润对顺铂联合氟尿嘧啶同步放化疗的疗效及预后价值 |
| Predictive Value of Immune Cell Infiltration Characteristics in the Tumor Microenvironment of Esophageal Squamous Cell Carcinoma for Efficacy and Prognosis of Concurrent Chemoradiotherapy with Cisplatin and Fluorouracil |
| 投稿时间：2025-11-11 |
| DOI：10.11735/j.issn.1671-170X.2026.09.B010 |
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| 中文关键词: 食管肿瘤 肿瘤微环境 免疫细胞浸润 顺铂 氟尿嘧啶 同步放化疗 疗效 预后 |
| 英文关键词:esophageal neoplasms tumor microenvironment immune cell infiltration cisplatin fluorouracil concurrent chemoradiotherapy efficacy prognosis |
| 基金项目:陕西省自然科学基础研究计划项目（2023-JC-QN-0970）；西安交通大学第一附属医院院基金（2024-RK-12） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨食管鳞状细胞癌（esophageal squamous cell carcinoma，ESCC）患者放化疗前肿瘤微环境中免疫细胞浸润特征对顺铂联合氟尿嘧啶同步放化疗的疗效及预后的预测价值。［方法］ 纳入2020年2月至2022年4月于西安交通大学第一附属医院接受顺铂联合氟尿嘧啶同步放化疗的160例ESCC患者。采用免疫组织化学染色法检测治疗前肿瘤组织中CD3+ T细胞、CD8+ 细胞毒性T细胞、调节性T细胞（regulatory cells，Tregs）及CD163巨噬细胞的浸润密度。将近期疗效评价完全缓解、部分缓解、疾病稳定的患者纳入有效组，疾病进展患者纳入无效组。通过受试者工作特征（receiver operating characteristic，ROC）曲线分析免疫细胞浸润特征对疗效的预测价值；采用Kaplan-Meier 法和Cox比例风险模型分析其与3年生存率的关系。［结果］ 在160例患者中，完全缓解28例、部分缓解40例、疾病稳定50例、疾病进展42例。与有效组相比较，无效组CD8+ 细胞毒性T细胞浸润密度显著性降低，而 Tregs 及CD163型巨噬细胞浸润密度显著性升高（均 P＜0.05）。ROC曲线显示，CD8+ 细胞毒性T细胞、Tregs及CD163型巨噬细胞预测疗效的曲线下面积分别为0.846、0.898和0.877（均P＜0.001）。生存分析显示，CD8+ 细胞毒性T细胞高浸润组3年生存率显著性高于低浸润组（55.43% vs 35.29%，P<0.05），而Tregs（55.24% vs 30.91%）和CD163型巨噬细胞（53.10% vs 31.91%）低浸润组的3年生存率显著性优于高浸润组（均P＜0.05）。多因素Cox回归分析表明，CD8+ 细胞毒性T细胞低浸润、Tregs高浸润及CD163型巨噬细胞高浸润均为ESCC患者总生存期不良的独立危险因素。［结论］ ESCC肿瘤微环境中免疫细胞浸润特征与顺铂联合氟尿嘧啶同步放化疗的疗效及预后密切相关。CD8+ 细胞毒性T细胞、Tregs及CD163型巨噬细胞浸润密度可作为预测放化疗疗效和生存预后的潜在生物标志物，为ESCC患者个体化治疗及联合免疫调节策略的制定提供参考依据。 |
| 英文摘要: |
| Abstract： ［Objective］ To explore the predictive value of immune cell infiltration characteristics in the tumor microenvironment before chemoradiotherapy for the efficacy and prognosis of concurrent chemoradiotherapy with cisplatin and fluorouracil (5-FU) in patients with esophageal squamous cell carcinoma (ESCC). ［Methods］ A total of 160 ESCC patients who received concurrent chemoradiotherapy with cisplatin and 5-FU at the First Affiliated Hospital of Xi’an Jiaotong University from February 2020 to April 2022 were enrolled. The infiltration densities of CD3+ T cells， CD8+ cytotoxic T cells， regulatory T cells (Tregs)， and CD163 macrophages in pretreatment tumor tissues were detected by immunohistochemistry. Short-term efficacy was evaluated： patients with complete response (CR)， partial response (PR)， and stable disease (SD) were assigned to the response group， while those with progressive disease (PD) were assigned to the non-response group. Receiver operating characteristic(ROC) curve analysis was performed to assess the predictive value of immune cell infiltration characteristics for efficacy. The Kaplan-Meier method and Cox proportional hazards model were used to analyze the correlation of these characteristics with 3-year overall survival (OS). ［Results］ Among the 160 patients， 28 achieved CR， 40 PR， 50 SD， and 42 PD. Compared with the response group， the non-response group had significantly lower infiltration density of CD8+ cytotoxic T cells， and significantly higher infiltration densities of Tregs and CD163 macrophages (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of CD8+ cytotoxic T cells， Tregs， and CD163 macrophages for predicting efficacy were 0.846， 0.898， and 0.877， respectively (all P<0.001). Survival analysis revealed that the 3-year OS rate of the high CD8+ cytotoxic T cell infiltration group was significantly higher than that of the low infiltration group (55.43% vs 35.29%， P<0.05)， whereas the 3-year OS rates of the low Tregs group (55.24% vs 30.91%) and low CD163 macrophage group (53.10% vs 31.91%) were significantly better than those of the corresponding high infiltration groups (all P<0.05). Multivariate Cox regression analysis indicated that low CD8+ cytotoxic T cell infiltration， high Tregs infiltration， and high CD163 macrophage infiltration were independent risk factors for poor OS in ESCC patients. ［Conclusion］ Immune cell infiltration characteristics in the tumor microenvironment of ESCC are closely correlated with the efficacy and prognosis of concurrent chemoradiotherapy with cisplatin and fluorouracil. The infiltration densities of CD8+ cytotoxic T cells， Tregs， and CD163 macrophages can serve as potential biomarkers for predicting chemoradiotherapy efficacy and survival prognosis， providing a reference for individualized treatment and combined immunomodulatory strategies for ESCC patients. |
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