程序性死亡受体配体1在肛管鳞状细胞癌患者中的表达水平及其对生存预后影响的初步探索

Primary exploration of programmed death-ligand 1 expression in patients with anal squamous cell carcinoma and its effect on prognosis

目的探讨肛管鳞状细胞癌(anal squamous cell carcinoma,ASCC)患者中程序性死亡受体配体1(programmed death-ligand 1,PD-L1)的表达水平及其对患者预后的影响,以期为免疫治疗在ASCC患者中的临床应用提供依据。方法本研究为一项回顾性研究,收集了2016年5月至2024年1月在中山大学附属第一医院确诊并接受根治性放化疗的Ⅱ~Ⅲ期ASCC患者(n=20)的临床病理资料。利用免疫组织化学方法检测患者(n=14)肿瘤样本中PD-L1的表达水平,采用综合阳性评分(combined positive score,CPS)评价PD-L1染色强度。PD-L1阳性判读标准为CPS≥1,根据所有患者CPS值的中位数将患者分为PD-L1高表达组(CPS≥20,n=7)和低表达组(CPS<20,n=7),并采用Log-rank生存分析比较PD-L1高表达组和低表达组患者的生存预后。结果20例患者的中位随访时间为33.4个月。所有患者的3年总生存率、无进展生存率、无局部复发生存率和无远处转移生存率分别为83.9%、78.6%、92.9%和85.7%。14例患者的肿瘤样本PD-L1免疫组织化学检测均为阳性(CPS≥1)。生存分析结果显示,PD-L1高表达组和PD-L1低表达组患者的3年总生存率分别为80.0%和100%(P=0.371),3年无进展生存率分别为60.0%和100%(P=0.134),3年无局部复发生存率分别为100%和100%(P=1.000),3年无远处转移生存率分别为60.0%和100%(P=0.134)。结论ASCC患者中PD-L1表达阳性率高,PD-L1高表达和低表达患者生存预后无显著差异。

The purpose of this study is to explore programmed death-ligand 1(PD-L1)expression and its effect on prognosis of anal squamous cell carcinoma(ASCC)patients,so as to provide clinical basis for immunotherapy in ASCC patients.Method This is a retrospective study,and the clinical data of patients(n=20)who were diagnosed as stageⅡ-ⅢASCC and received curative chemoradiotherapy in the First Affiliated Hospital of Sun Yat-sen University between May 2016 and January 2024 were collected.PD-L1 expression levels in tumor samples(n=14)were tested by immunohistochemistry technique.PD-L1 expression intensity was evaluated by combined positive score(CPS).PD-L1 positive criterion was CPS≥1,and patients were divided into PD-L1 high-expression group(CPS≥20,n=7)and low-expression group(CPS≥20,n=7)according to the median value of CPS.The comparison of survival between PD-L1 high-expression group and low-expression group was calculated with the Log-rank test.Result The median follow-up time of 20 patients was 33.4 months.The 3-year overall survival(OS)rate,progression-free survival(PFS)rate,local-regional recurrence free survival(LRFS)rate and distance-metastasis free survival(DMFS)rate for all patients were 83.9%,78.6%,92.9%and 85.7%,respectively.Immunohistochemistry results of PD-L1 in 14 patients'tumor samples were all positive(CPS≥1).In survival analysis,the 3-year OS rate of patients with PD-L1 high-expression and PD-L1 low-expression were 80.0%and 100%(P=0.371),3-year PFS rate were 60.0%and 100%(P=0.134),3-year LRFS rate were 100%and 100%(P=1.000),and 3-year DMFS rate were 60.0%and 100%(P=0.134),respectively.Conclusion PD-L1 was highly expressed in ASCC patients,and there was no significant difference in survival prognosis between PD-L1 high-expression and PD-L1 low-expression groups.