程序性死亡受体配体1在直肠癌中的表达及其意义

Expression of programmed death ligand 1 in rectal cancer and its significance

目的探讨程序性死亡受体配体1(PD⁃L1)在直肠癌组织中的表达及其与患者临床病理特征和总生存之间的关系。方法回顾性分析2014年1月至2015年12月山西省肿瘤医院收治的200例初治直肠癌患者的临床资料,采用免疫组织化学法检测直肠癌组织中PD⁃L1表达,分析PD⁃L1表达与患者性别、年龄、肿瘤T分期、淋巴结转移、肿瘤分化程度、组织学类型、肿瘤TNM分期、中性粒细胞与淋巴细胞比值(NLR)及患者总生存之间的关系。结果PD⁃L1阳性表达率为24%(48/200)。淋巴结转移及高NLR(≥3.5)患者PD⁃L1阳性表达率高(均P<0.05)。PD⁃L1阳性组5年总生存率为42%,PD⁃L1阴性组为59%,两组总生存差异有统计学意义(P<0.05)。多因素分析结果显示,淋巴结转移(HR=3.456,95%CI 2.148~5.556,P<0.01)、NLR≥3.5(HR=1.871,95%CI 1.169~2.996,P=0.009)、PD⁃L1阳性表达(HR=2.187,95%CI 1.373~3.484,P=0.001)是直肠癌患者总生存的独立不良影响因素。结论PD⁃L1在直肠癌组织中高表达,PD⁃L1阳性表达与患者不良总生存相关。

Objective To investigate the expression of programmed death ligand 1(PD⁃L1)in rectal cancer tissues and the correlation of PD⁃L1 expression with clinicopathological characteristics and overall survival of patients.Methods The clinical data of 200 newly treated rectal cancer patients in Shanxi Provincial Cancer Hospital from January 2014 to December 2015 were retrospectively analyzed.The expression of PD⁃L1 in rectal cancer tissues was detected by immunohistochemistry.The correlations of PD⁃L1 expression with gender,age,tumor T stage,lymph node metastasis,tumor differentiation,histological type,tumor TNM stage,neutrophil⁃to⁃lymphocyte ratio(NLR)and overall survival of patients were analyzed.Results The positive expression rate of PD⁃L1 was 24%(48/200).The positive expression rate of PD⁃L1 was high in patients with lymph node metastasis and high NLR(≥3.5)(both P<0.05).The 5⁃year overall survival rate in PD⁃L1⁃positive group was 42%,and the PD⁃L1⁃negative group was 59%,and the difference between the two groups was statistically significant(P<0.05).The results of multivariate analysis showed that lymph node metastasis(HR=3.456,95%CI 2.148-5.556,P<0.01),NLR≥3.5(HR=1.871,95%CI 1.169-2.996,P=0.009),and PD⁃L1⁃positive expression(HR=2.187,95%CI 1.373-3.484,P=0.001)were independent adverse influencing factors for the overall survival of rectal cancer patients.Conclusion PD⁃L1 is highly expressed in rectal cancer tissues,and the positive expression of PD⁃L1 is associated with poor overall survival of patients.