老年局部晚期食管癌同步放化疗序贯信迪利单抗免疫治疗的疗效

doi:10.3969/j.issn.1006-5725.2025.03.009

Abstract

Abstract:

Objective To investigate the safety and efficacy of Tigio capsules combined with intensity-modulated radiation therapy （IMRT）， followed by sequential sintilimab immunotherapy in elderly patients with locally advanced esophageal cancer. Methods From December 2020 to December 2023， 96 elderly patients with locally advanced esophageal cancer treated in Wuxi People's Hospital and Suzhou Hospital affiliated to Nanjing Medical University were selected. Using a random number table method， patients were divided into reference group （n = 48） and combination group （n = 48）. The reference group received concurrent chemoradiotherapy， while the combination group received sequential sintilimab immunotherapy combined with concurrent chemoradiotherapy. The clinical efficacy， changes in tumor markers （CEA， CA199， AFP， CYFRA21-1）， immune levels （CD4⁺， CD8⁺， CD16⁺ CD56⁺ NK）， quality of life （QLICP-ES）， and the incidence of radiation esophagitis， and immune pneumonitis， and other toxic effects were analyzed. Results After three months of treatment， the combination group showed higher ORR and DCR than the reference group （P < 0.05）. Levels of CEA， CA199， AFP， and CYFRA21-1 were lower in the combination group， whereas CD4⁺， CD16⁺ CD56⁺ NK levels were higher （P < 0.05）. Additionally， common and esophageal cancer-specific scores of the Quality of Life Instruments for Cancer Patients-Esophagus Cancer（QLICP-ES） were lower in the combination group （P < 0.05）. The incidence of radiation esophagitis， and immune pneumonitis， and related toxic effects showed no significant difference between the two groups （P > 0.05）. Conclusion Concurrent chemoradiotherapy followed by sequential sintilimab immunotherapy significantly improves clinical efficacy in elderly patients with locally advanced esophageal cancer and does not increase significant treatment-related toxicity. This approach enhances patients' immune function and is worthy of further clinical application.

Key words: locally advanced esophageal cancer, elderly patients, Tegafur capsule, intensity-modulated radiation therapy, sintilimab

CLC Number:

R735.1

Hao WANG,Xiaoyi LU,Wenjie. WANG. Clinical efficacy of concurrent chemoradiotherapy followed by sequential sintilimab immunotherapy in elderly patients with locally advanced esophageal cancer[J]. The Journal of Practical Medicine, 2025, 41(3): 365-370.

Figures/Tables 6

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

References 25

1	朱武刚，翟晨彤，刘德干，等. 外周血中性粒细胞与淋巴细胞比值对老年转移性食管癌免疫治疗预后的影响［J］. 实用老年医学，2024，38（2）：171-175.
2	苏王辉，安雷，李宇星，等. 同步整合加量逆向调强放射治疗食管癌的剂量学参数及对放射性损伤的影响［J］. 中国医学装备，2023，20（5）：12-16. doi:10.3969/J.ISSN.1672-8270.2023.05.003 doi: 10.3969/J.ISSN.1672-8270.2023.05.003
3	兰峰，孙静，张永辉，等. 奥沙利铂联合替吉奥治疗对进展期食管癌患者生存时间的影响［J］. 贵州医科大学学报，2023，48（10）：1204-1208.
4	曾春丽，高杰，文海菠，等. 信迪利单抗联合化疗治疗晚期食管癌患者疗效及对血清VEGF、TGF-β1水平的影响［J］. 分子诊断与治疗杂志，2024，16（6）：1125-1129.
5	国家卫生健康委员会. 食管癌诊疗规范（2018年版）［J］. 中华消化病与影像杂志（电子版），2019，9（4）：158-192. doi:10.3877/cma.j.issn.2095-2015.2019.04.005 doi: 10.3877/cma.j.issn.2095-2015.2019.04.005
6	薛卫成. 介绍乳腺癌TNM分期系统（第7版）［J］. 诊断病理学杂志，2010，17（4）：241-244.
7	EISENHAUER E A， THERASSE P， BOGAERTS J， et al. New response evaluation criteria in solid tumours： revised RECIST guideline （version 1.1）［J］. Eur J Cancer， 2009， 45（2）：228-247. doi:10.1016/j.ejca.2008.10.026 doi: 10.1016/j.ejca.2008.10.026
8	戚艳波，李高峰，万崇华，等. 基于QLICP-ES量表的食管癌患者生命质量影响因素分析［J］. 重庆医学，2015，44（35）：4995-4997. doi:10.3969/j.issn.1671-8348.2015.35.030 doi: 10.3969/j.issn.1671-8348.2015.35.030
9	HE S， ZHAO C， TAO H， et al. A recombinant scFv antibody-based fusion protein that targets EGFR associated with IMPDH2 downregulation and its drug conjugate show therapeutic efficacy against esophageal cancer ［J］. Drug Deliv， 2022， 29（1）：1243-1256. doi:10.1080/10717544.2022.2063454 doi: 10.1080/10717544.2022.2063454
10	POOSARI A， NUTRAVONG T， NAMWAT W， et al. The relationship between P16 INK4A and TP53 promoter methylation and the risk and prognosis in patients with oesophageal cancer in Thailand ［J］. Sci Rep， 2022， 12（1）：10337. doi:10.1038/s41598-022-14658-0 doi: 10.1038/s41598-022-14658-0
11	CUI M， LEMMON K， JIN Z， et al. Esophageal carcinoma with SMARCA4 mutation： unique diagnostic challenges ［J］. Pathol Res Pract， 2023， 248：154692. doi:10.1016/j.prp.2023.154692 doi: 10.1016/j.prp.2023.154692
12	WU S， JIANG W， LI J， et al. Global burden of esophageal cancer attributable to smoking： a systematic analysis for the Global Burden of Disease Study 2019 ［J］. Front Oncol， 2023， 13：1223164. doi:10.3389/fonc.2023.1223164 doi: 10.3389/fonc.2023.1223164
13	ZHANG H， ZHAO C， ZHANG Y， et al. Multi-omics analysis revealed NMBA induced esophageal carcinoma tumorigenesis via regulating PPARα signaling pathway ［J］. Environ Pollut， 2023， 324：121369. doi:10.1016/j.envpol.2023.121369 doi: 10.1016/j.envpol.2023.121369
14	朱梅，程旭，钱晓涛. 放疗联合卡瑞利珠单抗或替吉奥治疗局部晚期食管癌的疗效［J］. 中国肿瘤外科杂志，2023，15（6）：536-540. doi:10.3969/j.issn.1674-4136.2023.06.003 doi: 10.3969/j.issn.1674-4136.2023.06.003
15	BLAKE C， LAI R， BROWN T， et al. Nutrition outcomes and treatment toxicities in patients with head and neck cancer receiving helical intensity-modulated radiotherapy ［J］. J Hum Nutr Diet， 2024， 37（1）：182-192. doi:10.1111/jhn.13243 doi: 10.1111/jhn.13243
16	CAI L， QU L， CHENG Y， et al. Study on the therapeutic effect of sintilimab combined with modified DCF regimen on advanced gastric cancer and its impact on Th1/Th2 immune balance ［J］. Anticancer Drugs， 2024， 35（8）：780-788. doi:10.1097/cad.0000000000001629 doi: 10.1097/cad.0000000000001629
17	郭浩，周淑妮，丁华，等. 同步加量调强与常规调强放射治疗食管癌的效果比较［J］. 中国医学物理学杂志，2023，40（2）：139-143. doi:10.3969/j.issn.1005-202X.2023.02.002 doi: 10.3969/j.issn.1005-202X.2023.02.002
18	谢耀莹，杨帆，李淑云，等. 曲妥珠单抗联合替吉奥治疗HER2阳性ⅢB-Ⅳ期老年胃癌的临床观察及对PI3K/AKT/mTOR信号通路的影响［J］. 老年医学与保健，2021，27（5）：929-933.
19	WEN L， ZHAO J， YANG Y， et al. Sintilimab-induced alopecia universalis in a patient with the anti-tumor effect of complete remission after hepatectomy ［J］. J Immunother， 2023， 46（6）：232-235. doi:10.1097/cji.0000000000000473 doi: 10.1097/cji.0000000000000473
20	CHEN Y， CHEN Y， WANG Z， et al. Clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer ［J］. Pak J Med Sci， 2022， 38（5）：1316. doi:10.12669/pjms.38.5.5311 doi: 10.12669/pjms.38.5.5311
21	HAO J， LIU W， ZHAO C， et al. The diagnostic significance of 64-slice spiral CT combined with serological CA19-9， Bcl-2， CYFRA21-1 detection in thoracic esophageal carcinoma［J］. Transl Cancer Res， 2021， 10（12）： 5383. doi:10.21037/tcr-21-2522 doi: 10.21037/tcr-21-2522
22	SUN N， YIN X， ZHONG Y， et al. Misdiagnosis of an α‑fetoprotein‑producing esophageal carcinoma： A case report and literature review［J］. Oncol Lett， 2016， 12（1）： 597-600. doi:10.3892/ol.2016.4664 doi: 10.3892/ol.2016.4664
23	ZHOU Z， GUAN B， XIA H， et al. Particle radiotherapy in the era of radioimmunotherapy ［J］. Cancer Lett， 2023， 567：216268. doi:10.1016/j.canlet.2023.216268 doi: 10.1016/j.canlet.2023.216268
24	王俊洁，徐龙，袁国盛，等. 信迪利单抗联合仑伐替尼二线治疗不可切除肝细胞肝癌的临床疗效及安全性［J］. 实用医学杂志，2022，38（9）：1130-1135. doi:10.3969/j.issn.1006-5725.2022.09.016 doi: 10.3969/j.issn.1006-5725.2022.09.016
25	LI H， TANG L， CHEN Y， et al. Development and validation of a nomogram for prediction of lymph node metastasis in early-stage breast cancer ［J］. Gland Surg， 2021， 10（3）：901. doi:10.21037/gs-20-782 doi: 10.21037/gs-20-782

组别	性别		年龄（x ± s）/岁	病变部位			TNM分期		病理分型
组别	男	女	年龄（x ± s）/岁	上段	中段	下段	Ⅲ期	ⅣA期	鳞状细胞癌	腺癌
联合组（n = 48）	30	18	65.18 ± 10.16	13	20	15	20	28	34	14
对照组（n = 48）	28	20	64.83 ± 9.97	14	22	12	17	31	37	11
t/χ ² 值	0.174		0.170	0.466			0.396		0.487
P值	0.676		0.865	0.792			0.529		0.485

组别	CR	PR	SD	PD	DCR	ORR
联合组（n = 48）	2（4.17）	28（58.33）	13（27.08）	6（12.50）	43（89.58）	30（62.50）
对照组（n = 48）	0（0.00）	14（29.17）	20（41.67）	13（27.08）	34（70.83）	14（29.10）
χ ² 值					5.315	10.741
P值					0.021	0.001

组别	CEA/（ng/mL）		CA199/（U/mL）		AFP/（μg/L）		CYFRA21-1/（μg/L）
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
联合组（n = 48）	3.64 ± 0.59	1.57 ± 0.32	13.92 ± 2.51	7.15 ± 1.28	5.51 ± 0.52	2.35 ± 0.11	5.08 ± 1.25	2.27 ± 0.79
对照组（n = 48）	3.71 ± 0.63	2.25 ± 0.47	14.15 ± 2.70	9.48 ± 2.32	5.49 ± 0.48	2.63 ± 0.19	5.11 ± 1.31	2.81 ± 0.82
t值	0.562	8.286	0.432	6.092	0.196	8.836	0.115	3.286
P值	0.576	0.000	0.667	0.000	0.845	0.000	0.909	0.001

组别	CD4⁺		CD8⁺		CD16⁺ CD56⁺ NK
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
联合组（n = 48）	68.46 ± 4.47	61.12 ± 4.64	23.25 ± 2.93	25.91 ± 1.95	23.37 ± 1.82	22.68 ± 2.47
对照组（n = 48）	68.11 ± 4.95	57.25 ± 5.08	22.89 ± 2.85	26.55 ± 2.02	23.95 ± 2.15	20.75 ± 1.89
t值	0.364	3.897	0.610	1.576	1.427	4.299
P值	0.717	0.000	0.543	0.118	0.157	0.000

组别	癌症共性		食管癌特异性
组别	治疗前	治疗后	治疗前	治疗后
联合组（n = 48）	145.21 ± 23.48	54.89 ± 11.45	68.10 ± 9.15	38.75 ± 7.62
对照组（n = 48）	146.35 ± 24.10	61.10 ± 12.73	70.25 ± 10.08	42.05 ± 8.25
t值	0.235	2.513	1.094	2.036
P值	0.815	0.014	0.277	0.045

Clinical efficacy of concurrent chemoradiotherapy followed by sequential sintilimab immunotherapy in elderly patients with locally advanced esophageal cancer

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 25

Related Articles 7

Recommended Articles

Metrics

Comments

组别	放射性食管炎		免疫相关不良反应		恶心呕吐		骨髓抑制
组别	1 ~ 2度	3 ~ 4级	1 ~ 2度	3 ~ 4级	1 ~ 2度	3 ~ 4级	1 ~ 2度	3 ~ 4级
联合组（n = 48）	23（47.92）	9（18.75）	38（79.17）	10（20.83）	27（56.25）	11（22.92）	19（39.58）	7（14.58）
对照组（n = 48）	28（58.33）	15（31.25）	42（87.50）	6（12.50）	33（68.75）	18（37.50）	24（50.00）	11（22.92）
χ ² 值	3.475		1.200		0.399		0.146
P值	0.062		0.273		0.527		0.703

[1]	Guojiang YIN,Bixi LI,Pengxiao WEI,Yuqin YAN,Xiaoyang SONG,Kun LI. Effect of anterior quadratus lumborum block at the lateral supra⁃arcuate ligament on postoperative analgesia and inflammatory response in elderly patients undergoing robot⁃assisted radical prostatectomy [J]. The Journal of Practical Medicine, 2024, 40(2): 202-206.
[2]	Xiaoxia WANG,Qiao HUANG,Min PENG,Tiemei. SHEN. Application of evidence⁃based standardized hospital discharge preparation service in elderly patients [J]. The Journal of Practical Medicine, 2023, 39(22): 3005-3009.
[3]	XIN Chao, GAO Ju, GE Yali, WU Keting, CHEN Xiaoping. . Effect of driving pressure ⁃directed individualized end ⁃breath positive pressure ventilation on cerebral hemodynamics and regional cerebral oxygen saturation in elderly patients undergoing robot⁃assisted lapa⁃ roscopic radical prostatectomy [J]. The Journal of Practical Medicine, 2023, 39(12): 1524-1528.
[4]	WANG Junjie, XU Long, YUAN Guosheng, XU Xiaoming, ZHOU Xiaoyuan, LUO Runqi.. Efficacy and safety of sintilimab in combination with lenvatinib therapy as second⁃line regimen for patients with unresectable hepatocellular carcinoma [J]. The Journal of Practical Medicine, 2022, 38(9): 1130-1135.
[5]	AN Yang, TONG Chaohui, ZHANG Suiyang, WANG Lei, XIE Jianxin, ZHANG Xuran.. Mechanism of meropenem continuous pumping in the treatment of senile sepsis in ICU [J]. The Journal of Practical Medicine, 2021, 37(6): 726-734.
[6]	YANG Wan, KONG Lingsuo, CHEN Lanren. Safety and feasibility of ramazolamtoluenesulfonic acid in painless gastroenteroscopy for elderly patients： A prospective randomized controlled trial [J]. The Journal of Practical Medicine, 2021, 37(20): 2665-2669.
[7]	CUI Jianguo, LIANG Shuqin, QI Jie, HU Mengfen, ZHAO Jie, SHI Doufei, MAO Yanhua, MI Baobin, MA Hui, ZHANG Qingtan. The short⁃term efficacy of low⁃dose combined with recombinant human brain natriuretic peptide and sacu⁃bitril⁃valsartan in the treatment of elderly patients with acute heart failure [J]. The Journal of Practical Medicine, 2020, 36(21): 2984-2989.