PD-1/PD-L1抑制剂联合化疗一线治疗广泛期小细胞肺癌的效果观察

刘杨; 赵论; 陈宇佛; 张珊珊; 武越; 史梦婷; 汪蕊

doi:10.16766/j.cnki.issn.1674-4152.004035

PD-1/PD-L1抑制剂联合化疗一线治疗广泛期小细胞肺癌的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.004035

蚌埠医科大学第一附属医院肿瘤内科，安徽蚌埠 233004

基金项目:

安徽省高等学校自然科学研究重点项目 2023AH052000

蚌埠医科大学自然科学研究重点项目 2022byzd042

详细信息

通讯作者:
汪蕊，E-mail: ruiwang1011@163.com

中图分类号: R734.2
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- 文章访问数: 18
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-11
- 网络出版日期: 2025-09-04

Clinical observation of PD-1/PD-L1 inhibitor combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer

Department of Medical Oncology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨程序性死亡受体-1(PD-1)/程序性死亡配体-1(PD-L1)免疫检查点抑制剂联合标准化疗在广泛期小细胞肺癌(ES-SCLC)初始治疗中的临床价值，以验证该方案的临床获益与风险特征。方法回顾性选取2021年1月—2023年6月蚌埠医科大学第一附属医院初诊收治的ES-SCLC患者60例，按不同治疗方案分为对照组(依托泊苷+顺铂/卡铂)32例和试验组(PD-1/PD-L1抑制剂+依托泊苷+顺铂/卡铂)28例。比较2组患者的临床疗效、肿瘤标志物水平和安全性。结果试验组较对照组的客观缓解率[71.43%(20/28) vs. 53.13%(17/32)，χ²=2.116，P=0.146]和疾病控制率[89.29%(25/28) vs. 75.00%(24/32)，χ²=2.036，P=0.154]均更高，但差异无统计学意义。截止到随访终止时间，试验组中位总生存期(OS)较对照组(14.0个月vs. 9.8个月，P=0.002)延长4.2个月；试验组中位无进展生存期(PFS)较对照组(5.6个月vs. 4.5个月，P=0.022)延长1.1个月。治疗后，2组的胃泌素释放肽前体[(88.55±13.48)pg/mL vs. (105.17±25.64)pg/mL]、神经元特异性烯醇化酶[(38.85±13.94)ng/mL vs. (48.65±12.71)ng/mL]差异均有统计学意义(P＜0.05)。2组3级及以上不良事件发生率差异无统计学意义[46.43%(13/28) vs. 43.75%(14/32), χ²=0.043，P=0.835]。结论 PD-1/PD-L1抑制剂联合化疗一线治疗ES-SCLC临床疗效好，能有效降低肿瘤标志物水平，改善患者的生存预后，安全性可靠。
- 广泛期小细胞肺癌 /
- 程序性死亡受体-1抑制剂 /
- 程序性死亡配体-1抑制剂 /
- 化疗
Abstract: Objective To investigate the clinical value of programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) immune checkpoint inhibitor combined with standard chemotherapy in the initial treatment of extensive small cell lung cancer (ES-SCLC), so as to comprehensively verify the clinical benefits and risk characteristics of the combined scheme. Methods The newly diagnosed ES-SCLC patients in the First Affiliated Hospital of Bengbu Medical University from January 2021 to June 2023 were analyzed retrospectively. According to different treatment schemes, 32 cases were divided into control group (etoposide+cisplatin/carboplatin) and 28 cases were divided into experimental group (PD-1/PD-L1 inhibitor+etoposide+cisplatin/carboplatin). The clinical therapeutic effect, tumor markers and adverse drug reactions of the two groups were compared. Results The objective remission rate [71.43% (20/28) vs. 53.13% (17/32), χ²=2.116, P=0.146] and disease control rate [89.29% (25/28) vs. 75.00% (24/32), χ²=2.036, P=0.154] in the experimental group were significantly higher than those in the control group, but the difference was not statistically significant. By the time of follow-up, the median overall survival (OS) of the experimental group was 4.2 months longer than that of the control group (14.0 months vs. 9.8 months, P=0.002). The median progression-free survival (PFS) in the experimental group was 1.1 months longer than that in the control group (5.6 months vs. 4.5 months, P=0.022). After treatment, there were statistically significant differences in the precursor of gastrin-releasing peptide [(88.55±13.48) pg/mL vs. (105.17±25.64) pg/mL] and neuron specific enolase [(38.85±13.94) ng/mL vs. (48.65±12.71) ng/mL] between the two groups (P < 0.05). There was no statistically significant difference in the incidence of grade 3 and above adverse events between the two groups [46.43% (13/28) vs. 43.75% (14/32), χ²=0.043, P=0.835]. Conclusion PD-1/PD-L1 inhibitor combined with standard chemotherapy regimen is effective in the first-line treatment of ES-SCLC, which can effectively reduce the level of tumor markers and improve the survival prognosis of patients with good safety.
- Extensive-stage small cell lung cancer /
- Programmed death receptor-1 inhibitor /
- Programmed death ligand-1 inhibitor /
- Chemotherapy

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图 1 ES-SCLC患者Kaplan-Meier总生存时间曲线比较

Figure 1. Comparison of Kaplan-Meier total survival time curves in patients with ES-SCLC

下载: 全尺寸图片幻灯片

图 2 ES-SCLC患者Kaplan-Meier无进展生存时间曲线比较

Figure 2. Comparison of Kaplan-Meier progression-free survival time curves in patients with ES-SCLC

下载: 全尺寸图片幻灯片

表 1 2组ES-SCLC患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with ES-SCLC

组别	例数	性别(男性/女性，例)	年龄 (x±s，岁)	体重 (x±s, kg)	吸烟史 (有/无，例)	脑转移 (有/无，例)	KPS评分 (x±s，分)
对照组	32	23/9	63.66±8.59	68.19±9.45	14/18	6/26	80.94±6.41
试验组	28	19/9	66.18±8.23	66.50±9.19	9/19	7/21	78.21±5.48
统计量		0.115^a	1.157^b	0.699^b	0.851^a	0.344^a	1.756^b
P值		0.735	0.252	0.487	0.356	0.558	0.084
注：^a为χ²值，^b为t值。

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表 2 2组ES-SCLC患者肿瘤标志物比较(x±s)

Table 2. Comparison of tumor markers between the two groups of patients with ES-SCLC (x±s)

组别	例数	ProGRP(pg/mL)		NSE(ng/mL)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	32	263.26±103.78	105.17±25.64^b	94.67±24.42	48.65±12.71^b
试验组	28	281.56±98.03	88.55±13.48^b	100.99±30.16	38.85±13.94^b
统计量		0.699^a	10.010^c	0.898^a	8.372^c
P值		0.487	0.002	0.373	0.005
注：^a为t值，^c为F值。与同组治疗前比较，^bP＜0.001。

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