Efficacy And Surgical Risk Evaluation Of Neoadjuvant Chemotherapy Combined With PD-1 Immunosuppressant For Locally Advanced Esophageal Squamous Cell Carcinoma

Objective:To study the efficacy and surgical risk of PD-1 Immunosuppressive drug combined with chemotherapy for locally advanced esophageal cancer,and to explore new adjuvant inflammatory predictorsMethod:174 patients who received surgery after neoadjuvant treatment for esophageal cancer in the First and Second Affiliated Hospital of Nanchang University and Jiangxi Cancer Hospital from January 2017 to March 2021 were collected through the review of the Ethics Committee,and were taken as the research objects for retrospec tive collection,including gender,age at the time of surgery,chemotherapy cycle,neoadjuvant chemotherapy drugs,C EA,ECOG,Dnlr,N lr,perioperative hospital stay,operation time The amount of bleeding,preoperative efficacy,postoperative complications,tumor location,and disease-free survival period of basic diseases(diabetes,hypertension,hyperlipidemia,cerebral infarction)shall be recorded in detail.The results were analyzed using SPSS(version 23.0).Chi-squared test was used for qualitative data,and Kruskal Wallis nonparametric test was used for grade data.The Kaplan Meier method and Log rank test were used to analyze long-term efficacy DFS and plot survival curves.The Cox proportional regression risk model was used to analyze the risk factors affecting disease-free survival time of patients.P<0.05 indicates statistical significance.Result:Objective response rate: 41.75%(43/103)in the chemotherapy group and 28.17%(20/71)in the chemotherapy group;Effective control rate: 89.32%(92/103)in the experimental group,77.46(55/71)in the control group,P=0.018,according to α= At the 0.05 level,the difference was statistically significant.According to the grade data,Kruskal Wallis non parametric test P=0.006 was used for postoperative ad verse events,which was statistically significant.The Kaplan Meier survival curve was used to compare the PFS of the two groups of patients and evaluate the long-term efficacy.According to the results of the Log Rank test(Log Rank P=0.01),it can be considered that there is a significant difference in DFS between the two groups of patients.According to the peripheral blood routine results after neoadjuvant therapy,the NLR value was calculated,and the ORR was 48.57%(17/35)and 38.23%(26/68)in patients with NLR>3 and<3,respectively.The DCR was 91.42%(32/35)and 88.14%(60/68),respectively,with no statistically significant differences.The Receiver operating characteristic was drawn with disease-free survival time as the dependent variable and DNLR as the independent variable.The optimal cut-off value of d NLR was determined as 2.72 according to the maximum value of Youden’s J statistic.The DNLR value was calculated based on the blood routine test results of the patients in the observation group before surgery.ORR was 38.10%(8 /21)and 42.68%(35 /82)respectively in patients with d NLR>2.72 and<2.72,and DCR was 90.47%(19 /21)and 89.02%(73 /82)respectively.The difference was not statistically significant.Conclusion:PD-1 Immunosuppressive drug combined with platinum+albumin paclitaxel neoadjuvant chemotherapy has good efficacy and safety for locally advanced esophageal squamous cell carcinoma,which can be used as a first-line choice for neoadjuvant treatment of locally advanced esophageal carcinoma.PD-1 Immunosuppressive drug combined with chemotherapy has no significant correlation with peripheral blood NLR and DNLR.