肿瘤PD-L1表达与非小细胞肺癌患者放疗效果及临床预后相关性

Correlation between tumor PD-L1 expression and radiotherapy efficacy and clinical prognosis in patients with non-small cell lung cancer

目的探讨非小细胞肺癌(NSCLC)患者中程序性死亡配体1(PD-L1)的表达水平及其与放疗疗效和临床预后的相关性,评估PD-L1作为潜在放疗增敏靶点的可行性。方法收集2020-01-01-2023-12-31临清市人民医院确诊的48例原发性NSCLC患者的肿瘤穿刺样本。患者均无法手术,并接受根治性放疗。采用免疫组织化学(IHC)方法检测PD-L1的表达水平,并根据表达水平分为高表达组(n=22)和低表达组(n=26)。同时,从癌症基因组图谱(TCGA)数据库中获取NSCLC患者的基因表达数据,用于进一步验证PD-L1表达与患者生存预后的关联性。χ^(2)检验和Kaplan-Meier生存分析评估PD-L1表达与放疗反应、无进展生存期(PFS)和总体生存期(OS)之间的关系。结果PD-L1高表达组中仅有27.27%的患者对放疗有响应,而低表达组的响应率为57.69%,χ^(2)=4.481,P=0.034,提示PD-L1高表达与放疗响应率显著降低相关。此外,PD-L1高表达还与淋巴结转移(χ^(2)=5.483,P=0.019)及晚期临床分期(χ^(2)=4.825,P=0.028)相关。Kaplan-Meier生存分析结果显示,PD-L1高表达组的中位OS为61.3个月,低于低表达组的86.0个月(HR=1.22,95%CI为1.05~1.42,P=0.010)。同样,PD-L1高表达组的中位PFS为15.7个月,而低表达组为30.8个月(HR=1.44,95%CI为1.15~1.79,P=0.001)。结论PD-L1高表达可能是NSCLC患者放疗抵抗和预后不良的独立预测因子,提示PD-L1有成为治疗靶点的潜力。联合放疗与免疫治疗可能为NSCLC患者提供更为有效的治疗策略。

Objective To investigate the expression level of programmed death ligand 1(PD-L1)in patients with non-small cell lung cancer(NSCLC)and its correlation with radiotherapy efficacy and clinical prognosis,evaluating the feasibility of PD-L1 as a potential radiosensitization target.Methods Tumor biopsy samples were collected from 48 primary NSCLC patients diagnosed at Linqing People's Hospital,Shandong Province,between January 1,2020,and December 31,2023.These patients were ineligible for surgery and subsequently received radical radiotherapy.Immunohistochemistry(IHC)was used to assess PD-L1 expression levels,categorizing patients into high expression(n=22)and low expression(n=26)groups.Gene expression data for NSCLC patients were also obtained from the cancer genome atlas(TCGA)database to further validate the association between PD-L1 expression and patient survival prognosis.Chi-square tests and Kaplan-Meier survival analysis were used to assess the relationship between PD-Ll expression and radiotherapy response,pro-gression-free survival(PFS),and overall survival(OS).Results Only 27.27%of patients in the high expression group responded to radiotherapy,compared to 57.69%in the low expression group(χ^(2)=4.481,P=0.034),which indicated that high PD-Ll expression was significantly associated with a reduced response rate to radiotherapy.Additionally,high PD-L1 expression was also significantly correlated with lymph node metastasis(χ^(2)=5.483,P=0.019)and advanced clinical stage(χ^(2)=4.825,P=0.028).In the Kaplan-Meier survival analysis,the median OS in the high PD-Ll expression group was 61.3 months,significantly lower than 86.0 months in the low expression group(HR=1.22,95%CI:1.05-1.42,P=0.010).Similarly,the median PFS was 15.7 months in the high expression group,compared to 30.8 months in the low expression group(HR=1.44,95%CI:1.15-1.79,P=0.001).Conclusions High PD-L1 expression may be an independent predictor of radiotherapy resistance and poor prognosis in NSCLC patients,indicating its potential as a therapeutic target.The combination of radiotherapy and immunotherapy may provide more effective treatment strategies for NSCLC patients.