程序性死亡受体配体1在肺腺癌中的表达及意义

Expression of programmed death ligand 1 in lung adenocarcinoma and its significance

目的探讨程序性死亡受体配体1(PD-L1)在肺腺癌组织中的表达及其与患者临床病理特征的关系。方法收集南京大学医学院附属鼓楼医院2018年1月至8月病理确诊的141例初治肺腺癌患者石蜡包埋标本,应用免疫组织化学EnVision法检测PD-L1蛋白在肺腺癌组织肿瘤细胞(TC)及肿瘤间质浸润淋巴细胞(IC)中的表达情况,根据TC和IC中PD-L1的表达百分比进行计分。PD-L1在TC中按表达百分比分为TC3(≥50%)、TC2(≥5%且<50%)、TC1(≥1%且<5%)、TC0(<1%);PD-L1在IC中按表达百分比分为IC3(≥10%)、IC2(≥5%且<10%)、IC1(≥1%且<5%)、IC0(<1%)。结果PD-L1在肺腺癌中的表达以TC1或IC1为阈值,阳性表达90例,阳性率63.8%(90/141);以TC3或IC3为阳性阈值,阳性表达17例,阳性率12.1%(17/141)。若以TC1或IC1为阳性阈值,PD-L1表达在不同性别、神经是否侵犯、胸膜是否侵犯患者间差异均有统计学意义(均P<0.05);若以TC3或IC3为阳性阈值,PD-L1在不同分化程度、临床分期、淋巴结转移有无、脉管是否侵犯、神经是否侵犯患者间差异均有统计学意义(均P<0.05);以TC1或IC1、TC3或IC3为阳性阈值,PD-L1表达均与神经侵犯相关(均P<0.05)。结论PD-L1表达与神经受侵相关,PD-L1抑制剂有望用于PD-L1高表达复发进展肺腺癌患者的治疗。

Objective To investigate the expression of programmed death ligand 1 (PD-L1) in lung adenocarcinoma tissues and its correlation with clinicopathological features of patients. Methods A total of 141 paraffin-embedded specimens of patients with newly diagnosed lung adenocarcinoma by pathology from January to August 2018 in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School were collected. The expression of PD-L1 in the tumor cells (TC) and tumor-infiltrating immune cells (IC) were detected by immunohistochemistry EnVision staining. Based on the percentage of expression, PD-L1 in TC and IC were divided into TC3 (≥50%), TC2 (≥5% and <50%), TC1 (≥1% and <5%), and TC0 (<1%);IC3 (≥10%), IC2 (≥5% and <10%), IC1 (≥1% and <5%), and IC0 (<1%). Results PD-L1 expression was positive in 90 cases, and the positive rate was 63.8%(90/141) at a TC1 or IC1 threshold. When a TC3 or IC3 threshold was applied, PD-L1 expression was positive in 17 cases, and the positive rate was 12.1%(17/141). In the TC1 or IC1 threshold group, PD-L1 expressions were different in patients with different sex, nerve invasion and pleural invasion, and the differences were statistically significant (all P < 0.05). While in the TC3 or IC3 threshold group, PD-L1 expressions were different in patients with different cell differentiation, clinical stage, lymphocyte infiltration, vascular invasion and nerve invasion, and the differences were statistically significant (all P < 0.05). In both TC1 or IC1 threshold group and TC3 or IC3 threshold group, PD-L1 expression was associated with nerve invasion (both P < 0.05). Conclusions PD-L1 expression is associated with nerve invasion. PD-L1 inhibitors expect to be used as a potential treatment strategy for recurrent and progressive lung adenocarcinoma patients with high level expression of PD-L1.