PD-1抑制剂联合化疗治疗老年复发性食管鳞状细胞癌的疗效和安全性

doi:10.3969/j.issn.1003-9198.2026.05.010

摘要/Abstract

摘要： 目的探讨程序性死亡蛋白1(PD-1)抑制剂联合化疗治疗老年食管鳞状细胞癌(ESCC)患者根治性放(化)疗后局部复发的疗效和安全性。方法纳入2018—2024年江苏省肿瘤医院收治的94例根治性放(化)疗后出现局部复发接受PD-1抑制剂联合化疗治疗的老年ESCC患者。评价其近期疗效、远期疗效和不良反应,采用单因素、多因素Cox回归模型分析总生存时间(OS)和无进展生存时间(PFS)的影响因素。结果 94例患者的客观反应率为28.7%(27/94),疾病控制率为87.2%(82/94)。中位随访26.1个月,中位OS和PFS分别为13.1个月(95%CI:10.2～16.0个月)和8.6个月(95%CI:5.9～11.3个月)。单因素Cox回归分析显示,复发后的美国东部肿瘤协作组(ECOG)评分、是否对治疗应答与患者的OS和PFS有关;复发模式与患者的PFS有关(均P＜0.05)。多因素Cox回归分析显示,复发后的ECOG评分是患者OS的独立影响因素。复发后的ECOG评分、复发模式和是否对治疗应答是患者PFS的独立影响因素。82例(87.2%)患者发生了不同级别的治疗相关不良反应,其中23.4%(22/94)患者发生≥3级不良事件。常见的不良事件为血液学毒性及肝肾功能异常等,免疫相关不良事件亦较常见,未发生治疗相关死亡。结论 PD-1抑制剂联合化疗治疗根治性放(化)疗后局部复发性老年ESCC安全、有效,能够使患者生存获益,可作为一种有效的治疗选择。

关键词: 食管鳞状细胞癌, 局部复发, 老年人, 免疫治疗, 程序性死亡蛋白1, 化学治疗

Abstract: Objective To evaluate the efficacy and safety of programmed cell death protein 1 (PD-1) inhibitor combined with chemotherapy in elderly patients with locoregionally recurrent esophageal squamous cell carcinoma (ESCC) after definitive radiotherapy or chemoradiotherapy. Methods This study enrolled 94 elderly patients with ESCC who presented with locoregional recurrence after definitive radiotherapy or chemoradiotherapy and received PD-1 inhibitor combined with chemotherapy at Jiangsu Cancer Hospital from 2018 to 2024. The short-term efficacy, long-term outcomes, and adverse reactions were recorded. Univariate and multivariate Cox regression models were established to identify the factors influencing overall survival (OS) and progression-free survival (PFS). Results The Objective response rate (ORR) was 28.7% (27/94) with a disease control rate (DCR) of 87.2% (82/94). With a median follow-up of 26.1 months, the median OS and median PFS were 13.1 months (95%CI: 10.2-16) and 8.6 months (95%CI: 5.9-11.3), respectively. Univariate Cox regression analysis revealed that post-recurrence Eastern Cooperative Oncology Group (ECOG) performance status and response to treatment were significantly associated with both OS and PFS, while recurrence pattern was significantly associated with PFS (all P<0.05). Multivariate Cox regression analysis identified that post-recurrence ECOG performance status was independent influencing factor for OS, and post-recurrence ECOG performance status, recurrence pattern, and response to treatment were independent influencing factors for PFS. A total of 82 patients (87.2%) presented with treatment-related adverse events (TRAEs), and 22 patients (23.4%) experienced ≥grade 3 events. Common TRAEs included hematologic toxicity and hepatic/renal dysfunction. Immune-related adverse events were also observed. No treatment-related deaths occurred. Conclusions PD-1 inhibitors combined with chemotherapy in elderly patients demonstrate a favorable safety profile and significant efficacy for locoregionally recurrent ESCC after definitive radiotherapy or chemoradiotherapy, representing a viable therapeutic option for survival benefit.

Key words: esophageal squamous cell carcinoma, local recurrence, aged, immunotherapy, programmed cell death protein 1, chemotherapy

中图分类号:

R 735.1

施禹西, 顾大勇, 周雷, 刘文倩, 温林春, 叶劲军. PD-1抑制剂联合化疗治疗老年复发性食管鳞状细胞癌的疗效和安全性[J]. 实用老年医学, 2026, 40(5): 484-489.

SHI Yuxi, GU Dayong, ZHOU Lei, LIU Wenqian, WEN Linchun, YE Jinjun. Efficacy and safety of PD-1 inhibitor combined with chemotherapy for recurrent esophageal squamous cell carcinoma in the elderly[J]. Practical Geriatrics, 2026, 40(5): 484-489.

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