摘要
背景卡瑞利珠单抗是近年应用于临床的靶向药物,在难治性霍奇金淋巴瘤、肝细胞癌中均有应用,且取得一定效果,但尚未见其在肺癌中应用的研究。目的探讨同步推量调强放疗(SMART)联合卡瑞利珠单抗治疗非小细胞肺癌(NSCLC)的临床疗效及其机制。方法选取2019年3月至2020年10月邯郸市中心医院收治的NSCLC患者126例为研究对象。采用简单随机化法将患者分为对照组和观察组,各63例。对照组采用常规放疗,观察组采用SMART联合卡瑞利珠单抗进行治疗。比较两组患者临床资料、临床疗效,治疗前、治疗6周后血清肿瘤血管生成因子〔包括碱性成纤维细胞生长因子(b-FGF)、肿瘤特异性生长因子(TSGF)、血管内皮生长因子(VEGF)〕水平、动态对比增强磁共振成像(DCE-MRI)半定量参数〔包括达峰时间(TTP)、正性增强积分(PEI)、最大信号增强比率(SERmax)〕和血清转录因子21(TCF21)、白血病基因伴随蛋白x(Bax)、B细胞淋巴瘤2(Bcl-2)相对表达量,毒副作用、免疫性肺炎发生情况,生存曲线。结果观察组患者临床疗效优于对照组(P<0.05)。治疗6周后观察组患者血清b-FGF、TSGF、VEGF水平低于对照组(P<0.05)。治疗6周后观察组患者TTP短于对照组,PEI、SERmax高于对照组(P<0.05)。治疗6周后观察组患者血清TCF21、Bax相对表达量高于对照组,血清Bcl-2相对表达量低于对照组(P<0.05)。两组患者1~2级、3~4级反应性毛细血管增生症、白细胞计数下降、放射性食管炎、放射性肺炎发生率及免疫性肺炎发生率比较,差异无统计学意义(P>0.05)。治疗后12周,观察组失访1例,对照组失访2例,两组患者生存曲线比较,差异无统计学意义(P>0.05)。结论SMART联合卡瑞利珠单抗治疗NSCLC的临床疗效确切,且具有一定安全性,其机制与调节肿瘤血管生成因子、DCE-MRI半定量参数、凋亡基因及抑癌基因的表达有关。
Background Carrelizumab is a targeted drug that has been used clinically in recent years. It has been used in refractory classic Hodgkin’s lymphoma and hepatocellular carcinoma, and has achieved certain effect, but there is no research on its application in lung cancer. Objective To explore the clinical efficacy and mechanism of simultaneous modulated accelerated radiotherapy(SMART) combined with carrelizumab in the treatment of non-small cell lung cancer(NSCLC).Methods A total of 126 patients with NSCLC treated in Handan Central Hospital from March 2019 to October 2020 were selected as the research objects. The patients were divided into control group and observation group by simple randomization method, with 63 cases in each group. The control group was treated with conventional radiotherapy, and the observation group was treated with SMART combined with carrelizumab. The clinical data, clinical effect, tumor angiogenesis factors [including basic fibroblast growth factor(b-FGF), tumor specific growth factor(TSGF), vascular endothelial growth factor(VEGF) ], semi quantitative parameters of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI) [including time to peak(TTP),positive enhancement integral(PEI), maximum signal enhancement ratio(SERmax) ] and the relative expression of transcription factor 21(TCF21), Bcl-2 assaciated x protein(Bax) and B cell lymphoma 2(Bcl-2) before treatment and 6 weeks after treatment,incidence of adverse reactions, immune pneumonia and survival curve were compared between the two groups. Results The clinical effect of the observation group was better than that of the control group(P < 0.05). After 6 weeks of treatment, serum levels of b-FGF, TSGF and VEGF in the observation group were lower than those in the control group(P < 0.05). After 6 weeks of treatment, the TTP of the observation group was shorter than that of the control group, and the PEI and SERmax were higher than those of the control group(P < 0.05). After 6 weeks of treatment, the relative expression of serum TCF21 and Bax in the observation group was higher than that in the control group, and the relative expression of serum Bcl-2 was lower than that in the control group(P < 0.05). There was no significant difference between the two groups in the incidence of grade 1-2 and grade 3-4 reactive capillary hyperplasia, decrease of leukocyte count, radiation esophagitis, radiation pneumonia and immune pneumonia(P > 0.05). Twelve weeks after treatment, 1 case in the observation group and 2 cases in the control group were lost. There was no significant difference in the survival curve between the two groups(P > 0.05). Conclusion SMART combined with carrelizumab is effective and safe in the treatment of NSCLC. Its mechanism is related to the regulation of tumor angiogenesis factors, DCE-MRI semi-quantitative parameters, apoptosis genes and tumor suppressor genes.
作者
李方
侯晓明
刘峥
LI Fang;HOU Xiaoming;LIU Zheng(Oncology DivisionⅢ,Handan Central Hospital,Handan 056000,China)
出处
《实用心脑肺血管病杂志》
2021年第11期96-101,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
河北省卫生健康委2020年度河北省医学科学研究课题(20200465)。
关键词
癌
非小细胞肺
同步推量调强放疗
卡瑞利珠单抗
治疗结果
Carcinoma
non-small-cell lung
Simultaneous modulated accelerated radiotherapy
Carrelizumab
Treatment outcome
