抗核抗体对食管鳞癌化疗免疫疗效的预测分析-东南大学学报医学版

抗核抗体对食管鳞癌化疗免疫疗效的预测分析

单位：1. 南京大学医学院附属鼓楼医院肿瘤中心/南京大学临床肿瘤研究所, 江苏南京 210008;
2. 南京大学医学院附属鼓楼医院肺外科, 江苏南京 210008;
3. 南京大学医学院附属鼓楼医院食管外科, 江苏南京 210008;
4. 南京大学医学院附属鼓楼医院医学检验科, 江苏南京

关键词：食管鳞癌新辅助/转化化疗免疫治疗抗核抗体病理完全缓解

分类号：R735.1

出版年·卷·期（页码）：2025·44·第二期（167-174）

摘要：

目的:探讨局部晚期(临床分期为cT_2-4aN_1-3或cT_3-4aN₀M₀)食管鳞癌(ESCC)患者治疗前血清抗核抗体(ANA)对新辅助/转化化疗免疫治疗后疗效评估的预测价值。方法:回顾性分析2020年6月至2023年12月在南京大学医学院附属鼓楼医院肿瘤中心行新辅助/转化化疗免疫治疗的ESCC患者的临床资料。收集患者治疗前血清ANA表达水平及各项临床相关资料,采用卡方检验、单因素及多因素分析等统计方法,分析ANA及各项临床参数与患者的近期临床疗效及术后病理反应的相关性。结果:179例ESCC患者在接受了2周期化疗免疫治疗后行近期疗效评价,客观缓解率(ORR)为77.1%(138/179),疾病控制率(DCR)为98.3%。ANA阳性患者的ORR(86.9%)高于阴性患者(72.0%),差异有统计学意义(P＜0.05);ANA阳性组和阴性组的DCR分别为100%和97.5%,差异无统计学意义(P＞0.05)。138例中有97例实施手术切除,共24例(24.7%)达到病理完全缓解(pCR)。ANA阳性组的pCR率(39.3%)高于阴性组(18.8%),差异有统计学意义(P<0.05)。相对于男性,女性患者有更高的pCR率(P<0.05)。多因素分析显示,血清ANA阳性、女性是化疗免疫治疗后pCR的独立预测因素。结论:血清ANA可作为局部晚期ESCC患者新辅助/转化化疗免疫治疗后pCR预测的潜在生物标志物,值得进一步开展前瞻性研究深入探索。

Objective: To investigate the predictive value of antinuclear antibody(ANA) on the assessment of the efficacy of neoadjuvant/conversion chemoimmunotherapy in patients with locally advanced esophageal squamous cell carcinoma(ESCC)(cT_2-4aN_1-3or cT_3-4aN₀M₀). Methods: This study retrospectively analyzed ESCC patients treated with neoadjuvant/conversion chemoimmunotherapy from June 2020 to December 2023. The parameters of serum ANA before treatment were collected, and Chi-square test, univariate and multivariate analyses were performed to assess the recent efficacy and postoperative pathological response. Results: The objective response rate(ORR) and disease control rate(DCR) were 90.5% and 100% in 179 patients, respectively. The ORR(86.9%) was higher in positive ANA group than that in negative ANA group(72.0%), and the difference was statistically significant(P<0.05). DCR in the positive and negative ANA group was 100% and 97.5%, respectively. Of the 179 patients, 97 patients received surgery. A total of 24 cases(24.7%) achieved pathological complete response(pCR) after neoadjuvant/conversion chemoimmunotherapy. The pCR rate of ANA- positive patients(39.3%) was higher than that of ANA- negative patients(18.8%), and the difference was statistically significant(P<0.05). Compared with male patients, female patients had a higher pCR rate(P<0.05). Multivariate Logistic regression analysis showed that ANA positive and female were independent predictor of pCR in ESCC patients. Conclusion: Serum ANA can be used as a potential biomarker of pCR after neoadjuvant/conversion chemoimmunotherapy in patients with locally advanced ESCC.

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