摘要
目的程序性凋亡受体配体1(programmed death ligand-1,PD-L1)在多种肿瘤组织中存在过表达,然而关于其与食管鳞癌的研究尚不多见,本研究通过观察其在食管鳞癌石蜡组织中的表达情况,探讨其临床意义。方法收集河北医科大学第四医院2011-01-01-2011-08-31行根治性手术切除且淋巴结清除≥12枚的90例食管鳞癌石蜡组织标本,采用免疫组化方法检测PD-L1阳性表达。分析PD-L1阳性表达与临床病理特征和预后的关系,并进行多因素分析。结果PD-L1阳性表达率为30.0%(27/90),<60岁组PD-L1阳性表达率为46.3%,高于≥60岁组16.3%,χ2=9.576,P=0.002;淋巴结转移组PD-L1阳性表达率为41.3%,高于淋巴结阴性组26.1%,χ2=5.726,P=0.017;Ⅰ期PD-L1阳性表达率为3.7%,Ⅱ期为29.6%,Ⅲ期为65.7%,组间差异有统计学意义,χ2=7.891,P=0.019。全组患者中位总生存时间(overall survival,OS)为49.7个月,中位无进展生存期(progression-free-surviva,PFS)为27.5个月。PD-L1阳性表达组1、3、5年OS为68.0%、36.0%和32.0%,PFS为57.7%、30.8%和30.8%;阴性表达组1、3、5年OS为89.3%、62.5%和53.6%,PFS为85.7%、53.6%和50.0%。二者差异有统计学意义,χ2值分别为5.579和5.565,均P=0.018。PD-L1阳性表达与患者性别、病变位置、病变长度、T分期、肿瘤分化程度及脉管瘤栓情况均无相关。多因素分析显示,术后化疗为影响患者术后OS的独立影响因素(P=0.015),而淋巴结转移为影响患者术后OS(P<0.001)及PFS(P=0.001)的独立危险因素。结论食管鳞癌患者PD-L1阳性表达与年龄呈负相关,淋巴结阳性及pTNM分期较晚者PD-L1阳性表达率高。PD-L1阳性表达者预后差,术后化疗为影响患者术后OS的独立危险因素,而淋巴结转移是影响食管鳞癌患者术后OS和PFS的独立危险因素。
OBJECTIVE The expression of PD-L1（programmed death ligand-1）is overexpressed in many tumor tissues.However,researches on PD-L1 are still rare in ESCC.The purpose of this study was to observe the expression of programmed death ligand-1 in esophageal squamous cell carcinoma tissues,and to investigate their clinical significance.METHODS A total of 90 patients received radical esophagectomy at the fourth hospital of Hebei medical university between January 1 st,2011 to August 31 st,2011 and whose lymphadenectomy number was no less than 12 were involved in this study.Immunohistochemical method was used to detect the positive expression of PD-L1.SPSS 21.0 statistical software was used to analyze the relations between expression of PD-L1 and clinicopathologic features and prognosis in patients with esophageal squamous cell carcinoma and multivariate analysis was also conducted.RESULTS The positive expression of PD-L1 was 30.0%（27/90）.The positive expression of PD-L1 in60 years old group was significantly higher than those in ≥ 60 years old group（46.3% versus 16.3%,χ^2=9.576,P=0.002）.The positive expression of PD-L1 in with and without lymph node metastasis group was 41.3% and 26.1%,also had significant difference（χ^2=5.726,P=0.017）.The positive expression rate of PD-L1 in stage Ⅰ was 3.7%.While in stage Ⅱ was 29.6% and 65.7% in stageⅢ.There were significantly differences between each group（χ^2=7.891,P=0.019）.The median overall survival（OS）in the whole group was 49.7 months,and the median progression-free survival（PFS）was 27.5 months.The 1-,3-,5-year OS and PFS in PD-L1 positive expression group were 68.0%,36.0%,32.0% and 57.7%,30.8%,30.8% respectively,which was significantly lower than 89.3%,62.5%,53.6% and 85.7%,53.6%,50.0% in negative expression group（χ^2=5.579,P=0.018;χ^2=5.565,P=0.018）.The positive expression of PD-L1 was not correlated with gender,location and length of the tumor,T stage,tumor differentiation and blood vessel invasion.Cox regression analysis showed that postoperative adjuvant therapy was an independent risk factor for postoperative OS（P=0.015）,while lymph node metastasis was an independent risk factor for postoperative OS（P〈0.001）and PFS（P=0.001）.CONCLUSIONS The positive expression rate of PD-L1 in patients with lymph node metastasis and advanced pTNM stage are relatively higher,and both of them are negatively correlated with age.Patients with PD-L1 positive expression have poor prognosis.Postoperative adjuvant therapy is an independent risk factor for postoperative OS,while lymph node metastasis is an independent risk factor for postoperative OS and PFS in esophageal squamous cell carcinoma patients.
作者
关嵩
王军
刘月平
景绍武
曹峰
王祎
焦文鹏
武亚晶
程云杰
GUAN Song;WANG Jun;LIU Yue-ping;JING Shao-wu;CAO Feng;WANG Yi;JIAO Wen-peng;WU Ya-jing;CHENG Yun-jie(Fourth Hospital of Hebei Medical University, Shijiazhuang 050011 , P. R. China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第11期778-783,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管鳞癌
程序性凋亡受体配体1
临床病理特征
预后
esophageal squamous cell carcinoma
PD-L1
clinicopathological characteristics
prognosis
