免疫联合化疗对晚期NSCLC患者淋巴细胞免疫及生活质量的影响

doi:10.20223/j.cnki.1000-8535.2025.06.005

摘要/Abstract

摘要： 目的探讨免疫治疗联合化学治疗（化疗）对晚期非小细胞肺癌（NSCLC）患者淋巴免疫及生活质量的影响,为临床进一步治疗提供参考。方法选择2021年6月—2023年6月天津市滨海新区大港医院收治的晚期NSCLC患者120例进行研究,按抽签法分为干预组及对照组,每组60例,对照组采取单纯化疗方案,干预组采取免疫联合化疗方案,对比两组临床疗效、药物不良反应,治疗前后免疫功能（CD3⁺、CD4⁺、CD8⁺）、糖类抗原199（CA199）、糖类抗原 125（CA125）、血清癌胚抗原（CEA）水平及健康状态调查表（QOL）评分。结果干预组患者治疗总有效率高于对照组（68.33%>41.67%,P<0.05）;治疗后干预组患者CD3⁺、CD4⁺比例高于治疗前及对照组治疗后,CD8⁺比例低于治疗前及对照组治疗后（P<0.05）;治疗后干预组血清CA199、CA125、CEA水平均低于治疗前及对照组治疗后（P<0.05）;干预组药物不良反应发生率为16.67％,对照组为36.67％,干预组低于对照组（P<0.05）;治疗后干预组QOL各维度评分高于对照组及治疗前（P<0.05）。结论与单纯化疗相比,免疫联合化疗治疗晚期NSCLC患者,能有效降低肿瘤标志物水平,改善患者免疫指标,减轻药物不良反应,提高患者疗效及生活质量。

关键词: 非小细胞肺癌, 化疗, 免疫, 生活质量

Abstract: Objective To explore the effect of immunotherapy combined with chemotherapy on lymphatic immunity and quality of life of patients with advanced non-small cell lung cancer（NSCLC）,and to provide reference for further clinical treatment. Methods A total of 120 patients with NSCLC from June 2021 to June 2023 were selected and divided into observation group and control group evenly according to the method of drawing lots,control group was treated with chemotherapy,the observation group was treated with immunotherapy combined with chemotherapy,and the clinical efficacy and adverse drug reactions were compared between the two groups．Before and after treatment,immune function（CD3⁺,CD4⁺,CD8⁺）,carbohydrate antigen 199（CA199）,carbohydrate antigen 125（CA125）,serum carcinoembryonic antigen（CEA）levels and health status questionnaire（QOL-RRB- scores）were measured．Results The total effective rate in the observation group was significantly higher than that in the control group（68.33%>41.67%,P<0.05）．After treatment,the ratios of CD3⁺ and CD4⁺ in the observation group were significantly higher than those before treatment and control group after treatment,and the ratio of CD8⁺ was significantly lower than that before and after treatment in the control group（P<0.05）．After treatment,the serum levels of CA199,CA125 and CEA in the observation group were lower than those before and after treatment in the control group（P<0.05）．The incidence of adverse drug reactions was 16.67% in the observation group and 36.67% in the control group,which was significantly lower in the observation group than in the control group（P<0.05）．After treatment,the QOL scores in the observation group were significantly higher than those in the control group and before treatment（P<0.05）．Conclusions Compared with chemotherapy alone,immunotherapy combined with chemotherapy can effectively reduce the levels of tumor markers,improve the immune indexes of patients,reduce the adverse drug reactions,and improve the efficacy and quality of life of patients with advanced NSCLC．

Key words: non-small-cell lung cancer, chemotherapy, immunity, quality of life

武变荣, 骆玉霜. 免疫联合化疗对晚期NSCLC患者淋巴细胞免疫及生活质量的影响[J]. 广州医药, 2025, 56(6): 760-765.

WU Bianrong, LUO Yushuang. Effect of immunotherapy combined with chemotherapy on lymphocyte immunity and quality of life in patients with advanced NSCLC[J]. Guangzhou Medical Journal, 2025, 56(6): 760-765.

参考文献

[1] LEUNG C S K,van den EYNDE B J.Combining personalized neoantigen vaccination with chemotherapy and anti-PD-1 to treat NSCLC[J].Cancer Cell,2022,40(9):903-905.
[2] BAJBOUJ K,AL-ALI A,RAMAKRISHNAN R K,et al.Histone modification in NSCLC:Molecular mechanisms and therapeutic targets[J].Int J Mol Sci,2021,22(21):11701.
[3] PIRKER R.Chemotherapy remains a cornerstone in the treatment of nonsmall cell lung cancer[J].Curr Opin Oncol,2020,32(1):63-67.
[4] 张贤兰,朱玉斐,曾云云,等.化疗联合免疫及重组人血管内皮抑制素治疗晚期非小细胞肺癌的有效性及安全性分析[J].实用医学杂志,2023,39(16):2112-2115.
[5] 吴凯怡,吕学东,何海艳,等.冷冻消融联合免疫治疗在非小细胞肺癌治疗中的应用进展[J].实用医学杂志,2023,39(8):1058-1062 .
[6] 李昕,任典,贾超翼,等.NCCN非小细胞肺癌临床实践指南(2023V1、V2版)更新要点解读[J].中国肿瘤外科杂志,2023,15(2):105-110.
[7] PATIL N S,NABET B Y,MÜLLER S,et al.Intratumoral plasma cells predict outcomes to PD-L1 blockade in non-small cell lung cancer[J]. Cancer Cell,2022,40(3):289-300.
[8] 蔺敏,党苗苗,辛芳妮,等.百令胶囊对中晚期非小细胞肺癌化疗患者免疫功能、生活质量及远期生存的影响[J].癌症进展,2023,21(3):324-326.
[9] CHAFT J E,RIMNER A,WEDER W,et al.Evolution of systemic therapy for stages I-III non-metastatic non-small-cell lung cancer[J]. Nat Rev Clin Oncol,2021,18(9):547-557.
[10] WU Y L,ZHANG L,FAN Y,et al.Randomized clinical trial of pembrolizumab vs chemotherapy for previously untreated Chinese patients with PD-L1-positive locally advanced or metastatic non-small-cell lung cancer:KEYNOTE-042 China Study[J].Int J Cancer,2021,148(9):2313-2320.
[11] RIJAVEC E,INDINI A,GHIDINI M,et al.Nivolumab plus ipilimumab for the first-line treatment of metastatic NSCLC[J].Expert Rev Anticancer Ther,2021,21(7):705-713.
[12] WANG C,QIAO W,JIANG Y,et al.The landscape of immune checkpoint inhibitor plus chemotherapy versus immunotherapy for advanced non-small-cell lung cancer:A systematic review and meta-analysis[J].J Cell Physiol,2020,235(5):4913-4927.
[13] WANG L,DAI Y,ZHU F,et al.Efficacy of DC-CIK-based immunotherapy combined with chemotherapy in the treatment of intermediate to advanced non-small cell lung cancer[J].Am J Transl Res,2021,13(11):13076-13083.
[14] 任晓. 同步放化疗联合DC-CIK细胞生物疗法治疗中晚期非小细胞肺癌的有效率、不良反应及生活质量评价[J].药品评价,2020,17(8):35-36,48.
[15] LU D,LI T,YANG Z,et al.DC-CIK combined with chemotherapy on the efficacy,immune function,and life quality in colorectal cancer patients after radical resection[J].Am J Transl Res,2023,15(4):2793-2801.
[16] ZHANG X,YANG J,ZHANG G,et al.5 years of clinical DC-CIK/NK cells immunotherapy for acute myeloid leukemia - A summary[J].Immunotherapy,2020,12(1):63-74.
[17] ZHU J,YUAN Y,WAN X,et al.Immunotherapy(excluding checkpoint inhibitors)for stage I to III non-small cell lung cancer treated with surgery or radiotherapy with curative intent[J].Cochrane Database Syst Rev,2021,12(12):CD011300.
[18] 代莹,倪建佼,杨曦,等.免疫治疗时代ⅢA/B期非小细胞肺癌的治疗:放疗视角[J].实用肿瘤杂志,2023,38(2):110-116.
[19] WANG L,DAI Y,ZHU F,et al.Efficacy of DC-CIK-based immunotherapy combined with chemotherapy in the treatment of intermediate to advanced non-small cell lung cancer[J].Am J Transl Res,2021,13(11):13076-13083.
[20] WANG J,XU Y,RAO X,et al.BRD4-IRF1 axis regulates chemoradiotherapy-induced PD-L1 expression and immune evasion in non-small cell lung cancer[J].Clin Transl Med,2022,12(1):718.
[21] 邵汉成,倪斌.DC-CIK联合化疗对老年晚期非小细胞肺癌患者免疫功能的影响[J].中国老年学杂志,2024,44(7):1580-1583.
[22] KE W,ZHANG L,DAI Y.The role of IL-6 in immunotherapy of non-small cell lung cancer(NSCLC)with immune-related adverse events(irAEs)[J].Thorac Cancer,2020,11(4):835-839.
[23] TIAN Y,ZHAI X,YAN W,et al.Clinical outcomes of immune checkpoint blockades and the underlying immune escape mechanisms in squamous and adenocarcinoma NSCLC[J].Cancer Med,2021,10(1):3-14.
[24] PANG J,YU Q,CHEN Y,et al.Integrating Single-cell RNA-seq to construct a Neutrophil prognostic model for predicting immune responses in non-small cell lung cancer[J].J Transl Med,2022,20(1):531.
[25] LIU Z,WANG T,SHE Y,et al.N6-methyladenosine-modified circIGF2BP3 inhibits CD8+ T-cell responses to facilitate tumor immune evasion by promoting the deubiquitination of PD-L1 in non-small cell lung cancer[J].Mol Cancer,2021,20(1):105.
[26] WLOSIK J,FATTORI S,ROCHIGNEUX P,et al.Immune biology of NSCLC revealed by single-cell technologies:Implications for the development of biomarkers in patients treated with immunotherapy[J].Semin Immunopathol,2023,45(1):29-41.