2026 年第 1 期 第 21 卷

卡瑞利珠单抗介入时机对局部晚期不可切除非小细胞肺癌放疗患者肿瘤缓解率和免疫功能及生存预后的影响

The effect of the timing of camrelizumab intervention on the tumor response rate, immune function and survival prognosis of patients with locally advanced unresectable non-small cell lung cancer undergoing radiotherapy

作者：熊亮1张宁2于杨1赵廷1韩智国1成爱玲3

英文作者：Xiong Liang1 Zhang Ning2 Yu Yang1 Zhao Ting1 Han Zhiguo1 Cheng Ailing3

单位：1中国人民武装警察部队山东省总队医院呼吸科，济南250014；2山东省蒙阴县人民医院重症医学科，临沂276299；3山东省济南医院老年病科，济南250000

英文单位：1Department of Respiratory Shandong Provincial General Hospital of the Chinese People′s Armed Police Force Jinan 250014 China; 2Department of Critical Care Medicine Mengyin County Hospital Shandong Province Linyi 276299 China; 3Department of Geriatrics Jinan Hospital Shandong Province Jinan 250000 China

关键词：卡瑞利珠单抗；介入时机；不可切除非小细胞肺癌；肿瘤缓解率；生存预后

英文关键词：Camrelizumab;Timingofintervention;Unresectablenon-smallcelllungcancer;Tumorresponserate;Survivalprognosis

• 摘要：

• 目的 探讨卡瑞利珠单抗介入时机对局部晚期不可切除非小细胞肺癌（NSCLC）放疗患者肿瘤缓解率、免疫功能及生存预后的影响。方法 回顾性选取2018年1月至2020年2月就诊于中国人民武装警察部队山东省总队医院经放疗联合化疗（卡铂、培美曲塞与卡瑞利珠单抗）治疗的NSCLC患者140例，根据卡瑞利珠单抗介入时机分为对照组与观察组，各70例。对照组在放疗结束后第42~60天开始接受卡瑞利珠单抗治疗；观察组在放疗结束后第1~21天开始接受卡瑞利珠单抗。比较2组肿瘤缓解率、免疫功能水平、总生存期、无进展生存期以及不良反应发生情况。结果 治疗2个周期后，2组部分缓解比例、疾病进展比例、客观缓解率比较差异均有统计学意义（均P＜0.05）。治疗4个周期后，2组完全缓解比例、疾病稳定比例、客观缓解率比较差异均有统计学意义（均P＜0.05）。治疗2、4个周期后，2组CD+4、CD+4/CD+8比值均呈上升趋势，且观察组各时点均高于对照组，2组CD+8均呈降低趋势，且观察组各时点均低于对照组，差异均有统计学意义（均P＜0.05）。治疗4个周期后，2组自然杀伤细胞表达水平均高于治疗前和治疗2个周期后，且观察组均高于对照组，差异均有统计学意义（均P＜0.05）。随访48个月，观察组总生存期、无进展生存期均长于对照组［（37±4）个月比（29±6）个月、（31±3）个月比（24±4）个月］（均P＜0.001）。Kaplan-Meier生存曲线显示观察组累计生存率高于对照组（Log-rank χ2=24.873，P＜0.001）。2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论 卡瑞利珠单抗在局部晚期不可切除NSCLC放疗后患者的早期介入中，能够改善患者的肿瘤缓解率、免疫功能和生存预后。

• Objective To investigate the effect of the timing of camrelizumab intervention on the tumor response rate, immune function and survival prognosis of patients with locally advanced unresectable non-small cell lung cancer (NSCLC) undergoing radiotherapy. Methods A total of 140 patients with NSCLC treated with concurrent chemoradiotherapy (carboplatin, pemetrexed and camrelizumab) in Shandong Provincial General Hospital of the Chinese People′s Armed Police Force from January 2018 to February 2020 were retrospectively selected. According to the timing of camrelizumab intervention, the patients were divided into the control group and the observation group, with 70 cases in each group. The control group was treated with camrelizumab from days 42 to 60 after radiotherapy. The observation group received camrelizumab from day 1 to 21 after the end of radiotherapy. The tumor response rate, immune function, overall survival, progression-free survival and adverse reactions were compared between the two groups. Results After 2 cycles of treatment, there were significant differences in partial response rate, disease progression rate and objective response rate between the two groups (all P<0.05). After 4 cycles of treatment, there were significant differences in the complete remission rate, stable disease rate and objective response rate between the two groups (all P<0.05). After 2 and 4 cycles of treatment, the CD+4 and CD+4/CD+8 ratio of the two groups showed an upward trend, and those of the observation group were higher than those of the control group at each time point. The CD+8 in the two groups showed a downward trend, and those of the observation group were lower than those of the control group at each time point (all P<0.05). After 4 cycles of treatment, the expression levels of natural killer cells in the two groups were higher than those before treatment; after 2 cycles of treatment, those in the observation group were higher than those in the control group (all P<0.05). After 48 months of follow-up, the overall survival and progression-free survival of the observation group were longer than those of the control group ［(37±4)months vs (29±6)months, (31±3)months vs (24±4)months］(all P<0.001). Kaplan-Meier survival curve showed that the cumulative survival rate of the observation group was higher than that of the control group (Log-rank χ2=24.873, P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion  Camrelizumab can improve the tumor response rate, immune function and survival prognosis of patients with locally advanced unresectable NSCLC after radiotherapy.