信迪利单抗联合化疗对结直肠癌患者外周血免疫细胞影响的回顾性分析

Retrospective analysis of sintilimab plus chemotherapy on peripheral blood immune cells in colorectal cancer patients

摘要

目的: 探讨信迪利单抗联合化疗对Ⅱ~Ⅲ期结直肠癌患者术后外周血免疫细胞计数、炎症指标及对预后的影响。方法: 回顾性收集2021年1月—2023年12月首都医科大学附属北京世纪坛医院胃肠外科收治的35例Ⅱ~Ⅲ期结直肠癌患者资料。根据术后辅助治疗方案分为观察组(17例,信迪利单抗联合XELOX/FOLFOX方案)和对照组(18例,单纯XELOX/FOLFOX化疗)。比较两组患者治疗前后中性粒细胞淋巴细胞比率、单核细胞淋巴细胞比值、淋巴细胞单核细胞比值及各项白细胞亚群计数的变化。采用 Kaplan-Meier法和COX比例风险回归模型分析两组患者的无进展生存期(PFS)及预后影响因素。结果: 观察组治疗后淋巴细胞计数(1.40±0.63 vs 1.38±0.52,P=0.007)和嗜酸细胞计数(0.34±0.40 vs 0.16±0.18,P=0.004)较治疗前显著升高。对照组治疗后单核细胞计数升高(0.36±0.13 vs 0.35±0.09,P=0.011),嗜酸细胞计数下降(0.12±0.07 vs 0.13±0.11,P=0.031)。组间比较显示,观察组治疗后单核细胞计数(0.49±0.22 vs 0.35±0.12,P=0.039)和嗜酸细胞计数(0.33±0.39 vs 0.12±0.06,P=0.030)均显著高于对照组。生存分析显示,观察组3年PFS率显著高于对照组(88.2% vs 44.4%,P<0.05)。多因素COX回归分析表明,治疗方式是影响预后的独立保护因素[风险比(HR)=0.038,95%CI:0.003~0.444,P=0.009],联合信迪利单抗可显著降低疾病进展风险。结论: 信迪利单抗联合化疗可显著改善结直肠癌患者术后外周血淋巴细胞和嗜酸细胞水平,调节肿瘤微环境免疫状态,并显著提高3年PFS率。外周血免疫细胞计数可作为监测免疫治疗反应的潜在指标,但其长期临床意义及最佳应用人群仍需前瞻性大样本研究进一步验证。

Abstract

Objective: To explore the effects of sintilimab combined with chemotherapy on postoperative peripheral blood immune cell counts, inflammatory markers, and prognosis in patients with stage Ⅱ~Ⅲ colorectal cancer. Methods: A retrospective analysis was conducted on 35 patients with stage Ⅱ~Ⅲ colorectal cancer admitted to the Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, between January 2021 and December 2023. According to postoperative adjuvant treatment regimens, patients were divided into the observation group (n=17, sintilimab combined with XELOX/FOLFOX regimen) and the control group (n=18, XELOX/FOLFOX chemotherapy alone). Changes in neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), lymphocyte-to-monocyte ratio (LMR), and leukocyte subset counts were compared between the two groups before and after treatment. Kaplan-Meier method and Cox proportional hazards regression model were used to analyze progression-free survival (PFS) and prognostic factors in both groups. Results: In the observation group, lymphocyte count (1.40±0.63 vs 1.38±0.52, P=0.007) and eosinophil count (0.34±0.40 vs 0.16±0.18, P=0.004) were significantly increased after treatment compared with baseline. In the control group, monocyte count increased (0.36±0.13 vs 0.35±0.09, P=0.011), while eosinophil count decreased (0.12±0.07 vs 0.13±0.11, P=0.031) after treatment. Intergroup comparison showed that post-treatment monocyte count (0.49±0.22 vs 0.35±0.12, P=0.039) and eosinophil count (0.33±0.39 vs 0.12±0.06, P=0.030) in the observation group were significantly higher than those in the control group. Survival analysis showed that the 3-year PFS rate was significantly higher in the observation group than in the control group (88.2% vs 44.4%, P<0.05). Multivariate Cox proportional hazards regression analysis indicated that treatment regimen was an independent protective factor for prognosis (HR=0.038, 95%CI: 0.003~0.444, P=0.009), and sintilimab combined with chemotherapy significantly reduced the risk of disease progression. Conclusion: Sintilimab combined with chemotherapy significantly improved postoperative peripheral blood lymphocyte and eosinophil levels, modulated tumor microenvironment immune status, and markedly increased 3-year progression-free survival. Peripheral blood immune cell counts represent potential biomarkers for monitoring immunotherapy response, though their long-term clinical implications and optimal patient selection warrant further investigation in prospective, large-scale studies.

关键词

信迪利单抗 / 结直肠癌 / 免疫治疗 / 炎症指标 / 外周血免疫细胞 / 回顾性分析

Key words

sintilimab / colorectal cancer / immunotherapy / inflammatory indicators / peripheral blood immune cells / retrospective analysis

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