结直肠癌患者肿瘤出芽情况与临床病理特征、程序性死亡受体1及程序性死亡配体1表达相关性研究

Correlation between tumor budding and clinicopathological characteristics,expression of PD-1 and PD-L1 in CRC

目的:研究结直肠癌(CRC)患者肿瘤出芽情况与临床病理特征、程序性死亡受体1(PD-1)及程序性死亡配体1(PD-L1)表达的相关性。方法:回顾性分析行根治术治疗的180例CRC患者的临床资料。采用HE染色评估石蜡切片标本中肿瘤出芽情况。采用免疫组织化学染色显示肿瘤不出芽和出芽区域PD-1和PD-L1蛋白表达情况。采用多因素Logistic回归分析肿瘤出芽情况与临床病理特征的相关性。比较不同出芽情况CRC患者的5年生存率。结果:180例CRC患者中,肿瘤低出芽者50例,肿瘤高出芽者70例,无出芽者60例,肿瘤出芽率为66.67%。免疫组织化学染色结果显示,肿瘤细胞PD-1、PD-L1蛋白不着色或着色<1%;PD-1表达于肿瘤间质浸润的淋巴细胞,局灶区阳性细胞数<5%,判定为阴性。低出芽和高出芽CRC患者病理分期、肿瘤形态、肠壁浸润深度以及转移情况比较差异具有统计学意义(均P<0.05)。Logistic多因素回归分析结果显示,病理分期、肿瘤形态、肠壁浸润深度以及转移情况为影响CRC患者肿瘤出芽的独立危险因素(均P<0.05)。高出芽CRC患者5年总生存率低于低出芽CRC患者(P<0.05)。结论:肿瘤不出芽和出芽与PD-1、PD-L1蛋白表达无相关性。病理分期、肿瘤形态、肠壁浸润深度以及转移情况等病理特征是影响CRC患者肿瘤出芽的危险因素,可为制定术后辅助治疗方案和判断预后提供指导。

Objective:To study the correlation between tumor budding and clinicopathological characteristics,the expression of programmed cell death-1(PD-1)and programmed cell death-ligand 1(PD-L1)in colorectal cancer(CRC).Methods:The clinical data of 180 patients with CRC who underwent radical surgery were retrospectively analyzed.HE staining was used to evaluate tumor budding in paraffin section specimens.Immunohistochemical staining was used to show the expression of PD-1 and PD-L1 protein in non-tumor budding area and tumor budding area.Multivariate Logistic regression was used to analyze the correlation between tumor budding and clinicopathological characteristics.The 5-year survival rate of CRC patients with different budding conditions was compared.Results:Of the 180 patients with CRC,50 patients had low tumor budding,70 patients had high tumor budding,and 60 patients had no budding,with a tumor budding rate of 66.67%.Immunohistochemical staining showed that the PD-1 and PD-L1 proteins of tumor cells were not stained or stained less than 1%;PD-1 was expressed in lymphocytes infiltrated by the tumor stroma,and positive cell count in the focal area was lower than 5%,which was defined as negative.There were statistically significant differences in pathological stage,tumor morphology,intestinal wall infiltration depth and metastasis between the low budding group and the high budding group(all P<0.05).Multivariate Logistic regression analysis showed that pathological stage,tumor morphology,intestinal wall infiltration depth and metastasis were independent risk factors of tumor budding in CRC(all P<0.05).The 5-year overall survival rate of CRC patients with high budding was lower than that of patients with low budding(P<0.05).Conclusion:Tumor non-budding and budding have no correlation with PD-1 and PD-L1 proteins expression.Pathological characteristics such as pathological stage,tumor morphology,intestinal wall infiltration depth and metastasis are risk factors of tumor budding in patients with CRC,which can provide guidance for the formulation of postoperative adjuvant treatment programs and prognosis.