【摘要】 目的 探讨安罗替尼通过抑制VEGF通路重塑免疫抑制性肿瘤微环境，联合PD-1抑制剂二线治疗老年晚期肺腺癌的疗效，并评估其安全性及对肿瘤微环境的动态影响。方法 选取老年晚期肺腺癌患者150例，按随机数字表法分为对照组和观察组，每组75例。对照组采用安罗替尼二线治疗，观察组采用安罗替尼联合PD-1抑制剂(纳武利尤单抗、帕博利珠单抗)二线治疗，对比两组临床疗效、肿瘤标志物水平、新生血管指标、不良反应及生存情况。结果 观察组DCR为77.33%、1年总体生存率为44.00%,均高于对照组(57.33%、24.00%)(P<0.05)。治疗后观察组CYFRA21-1、CA125、CEA、VEGF-A、VEGFR2水平均低于对照组(P<0.05)。结论 安罗替尼联合PD-1抑制剂能够有效降低肿瘤标志物和新生血管指标水平，并提高患者1年生存率。该联合治疗方案安全性良好，未显著增加不良反应。更多还原

【Abstract】 Objective To explore the efficacy of anlotinib in the second-line treatment of elderly patients with advanced lung adenocarcinoma by reshaping the immunosuppressive tumor microenvironment by inhibiting the VEGF pathway in combination with PD-1 inhibitors, and to evaluate its safety and dynamic impact on the tumor microenvironment.Methods A total of 150 elderly patients with advanced lung adenocarcinoma were selected and divided into the control group and the observation group according to the random number table method, with 75 cases in each group.The control group was treated with anlotinib as second-line treatment, and the observation group was treated with anlotinib combined with PD-1 inhibitors(nivolumab, pembrolizumab)as second-line treatment.The clinical efficacy, tumor marker levels, neovascularization indicators, adverse reactions and survival conditions of the two groups were compared.Results The DCR of the observation group was 77.33% and the 1-year overall survival rate was 44.00%,both of which were higher than those of the control group(57.33%,24.00%)(P<0.05).After treatment, the levels of CYFRA21-1,CA125,CEA,VEGF-A and VEGFR2 in the observation group were all lower than those in the control group(P<0.05).Conclusion Anlotinib combined with PD-1 inhibitors can effectively reduce the levels of tumor markers and neovascular indicators, and improve the 1-year survival rate of patients.This combined treatment regimen has good safety and does not significantly increase adverse reactions.更多还原