摘要
目的探讨深部热疗联合恩度及nab-PC方案(白蛋白结合型紫杉醇+卡铂)治疗驱动基因阴性且程序性死亡受体配体-1(PD-L1)表达阴性的晚期肺鳞癌的临床疗效及安全性。方法选取2020年6月至2023年2月我院收治的96例驱动基因阴性且PD-L1表达阴性的晚期肺鳞癌患者作为研究对象,按随机数字表法分为对照组48例与观察组48例。对照组接受恩度及nab-PC方案治疗,观察组则接受深部热疗联合恩度及nab-PC方案治疗。两组均以3周为1个疗程,连续治疗4个疗程。对比治疗前后两组血清鳞状细胞癌抗原(SCCA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)、基质金属蛋白酶-2(MMP-2)、MMP-9、血管内皮生长因子(VEGF)、表皮生长因子受体(EGFR)、CC趋化因子配体5(CCL5)、CCL20水平;运用癌症治疗功能评价系统-肺癌模块(FACT-L)于治疗前后评估两组生存质量;比较两组药物相关不良反应、近期疗效及生存情况;统计观察组深部热疗相关并发症发生情况。结果治疗后,两组患者血清肿瘤标志物(SCCA、NSE、CYFRA21-1)、基质金属蛋白酶(MMP-2、MMP-9)、生长因子(VEGF、EGFR)、趋化因子(CCL5、CCL20)水平均显著低于治疗前,且观察组显著低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者FACT-L评分均显著高于治疗前,且观察组显著高于对照组,差异均有统计学意义(P<0.05)。两组患者肌肉痛/关节痛、血小板计数、胃肠道反应等各项药物相关不良反应发生率比较,差异均无统计学意义(P>0.05)。48例观察组患者中,1例热疗过程中出现全身温度过高,3例热疗后出现局部皮肤红肿,2例热疗后出现皮下疼痛和硬结,以上并发症均可控且不影响治疗进程;所有患者未见其他严重并发症。观察组客观缓解率(ORR)、疾病控制率(DCR)均高于对照组,差异有统计学意义(P<0.05)。观察组中位无进展生存期(PFS)和中位总生存期(OS)分别为6.9个月(95%CI:4.76~8.41)、14.2个月(95%CI:10.72~19.62),均长于对照组的4.3个月(95%CI:3.31~6.54)、10.3个月(95%CI:6.69~14.18),差异有统计学意义(P<0.05)。结论深部热疗联合恩度及nab-PC方案可显著降低血清肿瘤相关因子水平,改善生存质量与预后,且安全性良好,为驱动基因阴性/PD-L1阴性晚期肺鳞癌患者提供了新的治疗选择。
Objective To investigate the clinical efficacy and safety of deep hyperthermia combined with Endostar and nab-PC regimen(albumin-bound paclitaxel+carboplatin)in the treatment of advanced lung squamous cell carcinoma with negative driver gene and negative expression of programmed cell programmed death-ligand 1(PD-L1).Methods Ninety-six patients with driver gene-negative and PD-L1-negative advanced lung squamous cell carcinoma admitted to our hospital between June 2020 and June 2023 were selected as the study objects,and were divided into control group(48 cases)and ob⁃servation group(48 cases)according to random number table method.The control group was treated with Endostar and nab-PC regimen,and the observation group was treated with deep hyperthermia combined with Endostar and nab-PC regimen.Both groups were treated with a course of 3 weeks for 4 consecutive courses.The serum levels of squamous cell carcinoma antigen(SCCA),neuron-specific enolase(NSE),cytokeratin fragment 19(CYFRA21-1),matrix metalloproteinase-2(MMP-2),MMP-9,vascular endothelial growth factor(VEGF),epidermal growth factor receptor(EGFR),CC chemokine li⁃gand 5(CCL5),and CCL20 were compared before and after treatment.The quality of life of the two groups was evaluated by the Functional Assessment of Cancer Treatment-Lung(FACT-L)before and after treatment.Drug-related adverse reac⁃tions,short-term efficacy,survival outcomes were compared between the two groups,and the hyperthermia-related compli⁃cations in the observation group were analyzed.Results After treatment,serum levels of tumor markers(SCCA,NSE,CY⁃FRA21-1),matrix metalloproteinases(MMP-2,MMP-9),growth factors(VEGF,EGFR),and chemokines(CCL5,CCL20)significantly decreased in both groups compared to pretreatment levels,with the observation group showing significantly lower levels than the control group(all P<0.05).The FACT-L scores were significantly increased post-treatment in both groups,with higher scores in the observation group(P<0.05).No significant differences were observed in drug-related ad⁃verse reactions(e.g.,myalgia/arthralgia,thrombocytopenia,gastrointestinal reactions)between the two groups.Among the 48 patients of the observation group,1 patient experienced transient hyperthermia during treatment,3 had local skin red⁃ness and swelling,and 2 reported subcutaneous pain and induration after deep hyperthermia;all complications were man⁃ageable and did not interrupt treatment.The observation group exhibited higher objective response rate(ORR)and disease control rate(DCR)than the control group(P<0.05).The median progression-free survival and median overall survival in the observation group were 6.9 months(95%CI:4.76-8.41)and 14.2 months(95%CI:10.72-19.62),respectively,which were significantly longer than those in the control group[(4.3 months(95%CI:3.31-6.54)and 10.3 months(95%CI:6.69-14.18)]were prolonged,the difference was statistically significant(P<0.05).Conclusion Deep hyperthermia combined with Endostar and nab-PC regimen significantly reduces serum tumor-related factor levels,improves quality of life and progno⁃sis,and demonstrates good safety,offering a novel therapeutic option for driver gene-negative/PD-L1-negative advanced lung squamous cell carcinoma patients.
作者
周红梅
肖敬
李超
任宏伟
ZHOU Hongmei;XIAO Jing;LI Chao;REN Hongwei(Department of Pulmonary Disease,the Seventh People's Hospital of Hebei Province,Dingzhou,073000,Hebei,China;Department of Oncology,the Seventh People's Hospital of Hebei Province,Dingzhou,073000,Hebei,China)
出处
《肿瘤药学》
2025年第2期221-228,共8页
Anti-Tumor Pharmacy
关键词
肺鳞癌
深部热疗
程序性死亡蛋白配体-1
恩度
化疗
驱动基因
Lung squamous cell carcinoma
Deep hyperthermia
Programmed death-ligand 1
Endostar
Chemothera⁃py
Driver gene
