目的 分析卡瑞利珠单抗联合白蛋白紫杉醇和卡铂治疗晚期食管癌的临床效果。方法 选择2020年1月—2021年10月安徽医科大学第一附属医院医院东城院区收治的晚期食管鳞状细胞癌患者96例，按随机抽签法分为对照组（48例）和治疗组（48例）。对照组患者静脉滴注注射用紫杉醇（白蛋白结合型）和卡铂注射液治疗，第1、8天滴注注射用紫杉醇（白蛋白结合型），125 mg/m²；第1天静脉滴注卡铂注射液，200～400 mg/m²。治疗组在对照组基础上静脉滴注注射用卡瑞利珠单抗，第1天，200 mg/次，每3周1次。21 d为1个周期，两组治疗2个周期。观察两组患者临床疗效，比较治疗前后两组患者生存期、免疫功能指标、肿瘤标志物、血清炎症因子水平及程序性死亡-配体1（PD-L1）和肿瘤错配修复缺陷（dMMR）水平。结果 治疗后，治疗组24个月无进展生存（PFS）率、总生存率（OS）、客观缓解率（ORR）、疾病控制率（DCR）、疾病进展时间（TTP）均明显高于对照组（P＜0.05）。治疗后，两组T淋巴细胞（T_总）、Th、Th/Ts、自然杀伤细胞（NK）、树状突细胞（DC）、DC/单核巨噬细胞（PBMC）水平明显升高，而抑制性T细胞（Ts）、糖类抗原19-9（CA19-9）、癌胚抗原（CEA）、角蛋白19片段抗原21-1（CYFRA21-1）、鳞状细胞癌抗原（SCC-Ag）、TNF-α和IL-8水平明显降低（P＜0.05），且治疗组这些指标水平明显好于对照组（P＜0.05）。治疗后，治疗组PD-L1水平降低，而PD-L1＋/dMMR水平升高（P＜0.05），且患者预后良好组PD-L1水平降低、PD-L1＋/dMMR占比升高（P＜0.05）。结论 卡瑞利珠单抗联合白蛋白紫杉醇和卡铂治疗晚期食管癌可改善晚期食管鳞状细胞癌患者的肿瘤标志物水平，抑制炎性反应，提升免疫功能，提高患者的生存率。

Objective To analyze the effect of camrelizumab combined with albumin paclitaxel and carboplatin in treatment of advanced esophageal cancer. Methods Patients (96 cases) with advanced esophageal cancer in the First Affiliated Hospital of Anhui Medical University from January 2020 to October 2021 were divided into control group (48 cases) and treatment group (48 cases) by random drawing. Patients in the control group were iv administered with Paclitaxel for injection (Albumin Bound) and Carboplatin Injection. Paclitaxel for injection (Albumin Bound) was given intravenously on the 1st and 8th day, and Carboplatin Injection was injected intravenously at 125 mg/m²; on the 1st day, 200 — 400 mg/m². The treatment group were iv administered with Camrelizumab for injection on the basis of the control group, 200 mg/times on the first day, once every 3 weeks. A cycle had 21 days, and patients in two groups were treated for 2 cycles. After treatment, the clinical evaluations were evaluated, the progression-free survival, immune function indexes, tumor markers, serum inflammatory factor levels, and the levels of PD-L1 and dMMR in two groups before and after treatment were compared. Results After treatment, the 24-month PFS rate, OS, ORR, DCR, and TTP in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the levels of T total, Th, Th/Ts, NK, DC and DC/PBMC were significantly increased, while the levels of inhibitory Ts, CA19-9, CEA, CYFRA21-1, SCC-Ag, TNF-α and IL-8 were significantly decreased in the treatment group in two groups (P < 0.05), and the level of these indexes in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the level of PD-L1 was decreased and the level of PD-L1+/dMMR was increased in the treatment group, and the level of PD-L1 was decreased and the proportion of PD-L1+/dMMR was increased in the group with good prognosis (P < 0.05). Conclusion Camrelizumab combined with albumin paclitaxel and carboplatin in treatment of advanced esophageal cancer can improve the level of tumor markers, inhibit inflammatory response, enhance immune function and improve the survival rate of patients with advanced esophageal squamous cell carcinoma.

R979.1

合肥市卫健委基金项目（Hwk2022zc043）