微乳头或实体亚型肺浸润性非黏液腺癌与基因突变及PD-L1阳性表达的关系

Relationship of micropapillary or solid subtypes of lung infiltrating non-mucinous adenocarcinoma with gene mutation and positive expression of PD-L1

目的探讨微乳头或实体亚型(病理阳性)肺浸润性非黏液腺癌与基因突变及程序性死亡配体1(PD-L1)阳性表达的关系。方法肺浸润性非黏液腺癌患者178例分为病理阳性组(89例)和病理阴性组(89例)。二代基因测序法检测基因突变和免疫组化法检测PD-L1表达,比较两组的临床特征、基因突变率和PD-L1阳性表达率。分析影响基因突变和PD-L1阳性表达的危险因素。结果与病理阴性组比较,病理阳性组女性患者比例较低,年龄较大,肿瘤直径>3 cm和脏层胸膜转移患者比例较高(P<0.05)。两组病理分期比较有统计学差异(P<0.05)。病理阳性组基因突变率(58.4%vs.19.1%)和PD-L1阳性表达率(55.1%vs.11.2%)均高于病理阴性组(P<0.05)。病理阳性是影响基因突变的独立危险因素(P<0.05)。脏层胸膜转移和病理阳性是影响PD-L1阳性表达的独立危险因素(P<0.05)。结论微乳头或实体亚型肺浸润性非黏液腺癌患者更容易出现基因突变,若伴脏层胸膜转移则更易出现PD-L1阳性表达。

Objective To explore the relationship of micropapillary or solid subtypes(pathological positive)of the lung infiltrating non-mucinous adenocarcinoma with gene mutation and positive expression of programmed death-ligand 1(PD-L1).Methods A total of 178 patients with lung infiltrating non-mucinous adenocarcinoma were divided into two groups of A(pathological positive,89 cases)and B(non-pathological positive,89 cases).Gene mutation and PD-L1 expression were detected by next-gene sequencing and immunohistochemical method respectively.Clinical characteristics,gene mutation rate and positive expression rate of PD-L1 were compared between the two groups.The risk factors affecting gene mutation and positive expression of PD-L1 were analyzed as well.Results Compared with group B,group A had lower proportion of female patients,elder age,and higher proportions of the patients with tumor diameter>3 cm and visceral pleural metastasis(P<0.05).There was significant difference in pathological stage between two groups(P<0.05).The gene mutation rate and positive expression rate of PD-L1 were higher in group A than those in group B(58.4%vs.19.1%and 55.1%vs.11.2%)(P<0.05).Pathological positivity was an independent risk factor affecting gene mutation(P<0.05).Visceral pleural metastasis and pathological positivity were the independent risk factors affecting positive expression of PD-L1(P<0.05).Conclusion The patients with micropapillary or solid subtypes of lung infiltrating non-mucinous adenocarcinoma are more likely to have gene mutation,who are easier to have positive expression of PD-L1 if associated with visceral pleural metastasis.