宫颈癌组织程序性死亡配体-1的表达及其与患者临床病理特征、预后的关系研究

Expression of PD-L1 in cervical cancer and its relationship with clinicopathological features and prognosis of patients

目的探讨宫颈癌组织程序性死亡配体-1(PD-L1)的表达,并分析其与患者临床病理特征及预后的关系。方法选取2019年8月至2020年3月浙江省肿瘤医院收治的病理学诊断明确为宫颈癌的患者172例,采用免疫组织化学法检测宫颈癌术后留存的石蜡包埋组织切片PD-L1的表达情况,并分析PD-L1表达与患者临床病理特征及预后的关系。结果172例宫颈癌患者中PD-L1表达阳性166例,阳性表达率为96.51%。宫颈癌组织PD-L1表达阳性与高危型HPV感染、CA19-9水平、病理类型、分化程度均有关(均P<0.05),与患者年龄、怀孕次数、分娩次数、BMI、家族史、Hb水平、血清鳞状细胞癌抗原、癌胚抗原、CA125、初始治疗方式、肿瘤生长类型、肿瘤大小、淋巴结转移、脉管瘤栓、器官转移、肿瘤分期、合并其他癌症等均无关(均P>0.05)。多因素logistic回归分析显示,病理类型是患者宫颈癌组织PD-L1表达阳性的独立影响因素(OR=0.006,95%CI:0.009~0.387,P<0.05),PD-L1表达阳性患者中鳞癌比例高。宫颈癌组织PD-L1表达阳性患者2年无进展生存率(88.6%比50.0%)和2年总生存率(96.4%比66.7%)均高于PD-L1表达阴性患者(均P<0.05)。结论不同临床病理特征的宫颈癌患者PD-L1的表达各有差异,宫颈鳞癌表达阳性率最高,鳞癌患者从程序性死亡受体-1/PD-L1免疫抑制剂治疗中获益的可能性较大。

Objective To investigate the expression of programmed death ligand-1(PD-L1)in cervical cancer tissues and its relationship with clinicopathological features and prognosis of patients.Methods A total of 172 patients with patho-logically diagnosed cervical cancer treated in Zhejiang Cancer Hospital from August 2019 to March 2020 were enrolled.Im-munohistochemistry was used to detect PD-L1 expression in paraffin-embedded cancer tissue sections.The relationship of PD-L1 expression with clinicopathological characteristics and prognosis of patients were analyzed.Results Among the 172 cervical cancer patients,166(96.51%)were positive for PD-L1 expression.The positive expression of PD-L1 in cervical cancer tissues was related to high-risk HPV infection,CA199 level,pathological type,and degree of differentiation(all P<0.05),while not associated with patient's age,number of pregnancy or deliveries,BMI,family history,hemoglobin level,se-rum squamous cell carcinoma antigen(SCC),carcinoembryonic antigen(CEA),CA125,initial treatment mode,tumor growth type,tumor size,lymph node metastasis,vascular tumor thrombus,organ metastasis,tumor stage,combined with other can-cers(all P>0.05).Multivariate logistic regression analysis showed that the pathological type was an independent factor for the positive expression of PD-L1 in cervical cancer tissues(OR=0.006,95%CI:0.009-0.387,P<0.05).The proportion of squamous cell carcinoma in patients with positive expression of PD-L1 was high.The 2-year progression-free survival rate and the 2-year overall survival rate in cervical cancer patients with positive PD-L1 expression were higher than those with negative PD-L1 expression(88.6%vs.50.0%and 96.4%vs.66.7%;P<0.05).Conclusion The expression of PD-L1 is associated with clinicopathological features and prognosis of cervical cancer patients.Cervical squamous cell carcinoma has the highest positive rate,indicating that patients with squamous cell carcinoma are more likely to benefit from PD-1/PD-L1 therapy.