中国全科医学2026，Vol.29Issue(6)：710-717,8.DOI:10.12114/j.issn.1007-9572.2025.0208
进展期食管鳞状细胞癌免疫相关不良反应的预测因素及其与疗效相关性分析
Analysis of Predictors for Immune-related Adverse Events and the Correlation with Efficacy in Progressive Esophageal Squamous Cell Carcinoma
摘要
Abstract
Background Immunotherapy has become the standard regimen for progressive esophageal squamous cell carcinoma(ESCC),but there is a lack of clear biomarkers to predict immune-related adverse events(irAEs),and the relationship between irAEs and efficacy is also unclear.Objective To explore the predictive factors associated with the occurrence of irAEs in patients with progressive ESCC and the correlation between irAEs and prognosis.Methods A retrospective study was conducted on 118 patients diagnosed with progressive ESCC and treated with programmed death protein 1(PD-1)inhibitors at Nanjing Drum Tower Hospital from 2020 to 2023.The enrolled patients were followed up through access to medical records,outpatient visits,re-admissions,phone calls.Clinical data and occurrence of irAEs were collected.Patients were divided into the irAEs-positive group and the irAEs-negative group based on the occurrence of irAEs during treatment.Univariate and multivariate Logistic analysis were conducted to analyze the factors influencing the occurrence of irAEs.The efficacy was evaluated as complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD).Objective remission rate(ORR),disease control rate(DCR)were compared between the two groups.Kaplan-Meier survival curve were plotted,and Log-rank test was conducted to compare the progression free survival(PFS)and overall survival(OS)between the two groups.Results Among the 118 patients,47 cases(39.83%)experienced irAEs.The irAEs with higher incidence were dermal toxicity 21 cases(17.80%),endocrine toxicity 16 cases(13.56%)and pulmonary toxicity16 cases(13.56%).The comparison of autoantibody profiles and antinuclear antibody(ANA)between the irAEs-positive group and the irAEs-negative group showed a statistically significant difference(P<0.05).Univariate Logistic analysis showed that autoantibody profile positivity(OR=3.375,95%CI=1.527-7.456,P=0.003)and ANA positivity(OR=3.072,95%CI=1.404-6.722,P=0.005)were risk factors for the development of irAEs(P<0.05).Multivariate Logistic analysis showed that autoantibody profile positivity(OR=2.367,95%CI=0.841-6.663,P=0.103)and ANA positivity(OR=1.733,95%CI=0.621-4.837,P=0.293)were not significantly associated with the occurrence of irAEs.However,the incidence of endocrine toxicity was higher in autoantibody-positive patients than in autoantibody-negative patients,and the incidence of endocrine toxicity and myotoxicity was higher in ANA-positive patients than in ANA-negative patients(P<0.05).Moreover,the DCR of irAEs-positive group was longer than that of irAEs-negative group(χ2=6.690,P=0.010).Comparing the ORR of the two groups,the difference was not statistically significant(χ2=2.628,P=0.105).Survival analysis results showed that the median PFS and median OS of the irAEs-positive group were longer than those of the irAEs-negative group,all differences were statistically significant(PFS:χ2=9.521,P=0.002;OS:χ2=4.254,P=0.039).Conclusion Autoantibody profiles or ANA positivity may be more likely to develop irAEs after immunotherapy in patients with ESCC,and the occurrence of irAEs is associated with better efficacy.关键词
食管鳞状细胞癌/免疫治疗/免疫相关不良反应/自身抗体谱/抗核抗体/疗效Key words
Esophageal squamous cell carcinoma/Immunotherapy/Immune-related adverse events/Autoantibody profiles/Antinuclear antibody/Efficacy分类
医药卫生引用本文复制引用
杨海飞,孙武,吴成,任伟,李茹恬..进展期食管鳞状细胞癌免疫相关不良反应的预测因素及其与疗效相关性分析[J].中国全科医学,2026,29(6):710-717,8.基金项目
国家自然科学基金资助项目(82003198) （82003198）
